临床骨科杂志2016，Vol.19Issue(4)：395-399,5.DOI:10.3969/j.issn.1008-0287.2016.04.004
单开门椎管扩大成形术后颈椎曲度与C5神经根麻痹的关系
Comparison the probability of appearing C5 nerve injury after three kinds of surgical treat-ment of cervical spondylosis
肖善富 1张喜善 2李平 1董桂一1
作者信息
- 1. 单县东大医院骨科，湖西脊柱研究所，山东 单县274300
- 2. 泰山医学院附属医院骨科，山东 泰安 271000
- 折叠
摘要
Abstract
Objective To explore the relationship between the cervical curvature with the incidence of C5 nerve root palsy after single open-door posterior decompression. Methods A total of 254 cases of cervical spondylosis were treated with three different operations. Group A (126 cases) was operated by expansion of single open-door cervical laminoplasty;group B (70 cases) was operated by expansion of single open-door cervical laminoplasty and cervical lateral mass fixation with no significantly changed cervical curvature;group C (58 cases) was operated by expansion of single open-door cervical laminoplasty and cervical lateral mass fixation and rebuild physiological curvature of cervi-cal spine. Results All patients were followed up for 12~18 months. X-ray, MRI and CT showed that the spinal cords had drift back in varying degrees and all lateral mass screws were not into the intervertebral foramen and spinal canal and vertebral plate didn′t close the door again and vertebral plate hinges didn′t enter into the vertebral canals and no spinal epidural hematoma compressed the spinal cord obviously in all patients. The cervical curvatures had no change in group A. The cervical curvatures had slight change in group B. The cervical curvatures had obvious change in group C,and curvature change value was 5. 3 mm ± 2. 7 mm. Eighteen cases of patients appeard C5 nerve root palsy postoperatively. There were 2 cases of C5 nerve injury in group A and 4 cases of C5 nerve injury in group B and 12 ca-ses of C5 nerve injury in group C. The probability of appearing C5 nerve injury after three kinds of surgical treatment of cervical spondylosis were respectively 1. 59% ( group A ) , 5. 71% ( group B ) , 20. 69%( group C ) , 3. 09%(group myelopathic type) and 14. 13% (group mixed type). There was no significant difference between group A and B(P>0. 05). The difference between group C with group A and B were significant statistically (P<0. 017). Five cases of C5 nerve injury appeared in myelopathic type cervical vertebra disease, and 13 cases of C5 nerve injury appeared in the mixed type cervical spondylosis. The difference between group myelopathic type and group mixed type were significant statistically (P<0. 05). Eighteen cases of patients who had C5 nerve root palsy characterized for pain and hemp in neck and shoulder or aggravating of neck and shoulder pain and hemp, muscle strength of C5 innervation decline quickly, but hypesthsia decline were not obvious. All patients were given conservative treatment. Neck and shoulder pains of all patients disappeared after 2~3 weeks in postoperation. After 4~24 weeks, 11 cases of C5 nerve injury recovered fully. After 1 year, the another case of C5 nerve injury recovered to 4 + grade level of muscle strength of C5 innervation. Conclusions C5 nerve root injury can be appeared in all kinds of cervical spondylosis posterior expansion of open-door cervical laminoplasty. The lowest incidence rate is appeared in operation of single open-door posterior decompression. The incidence rate is lowest when cervical curvature changes significantly. The mechanism of C5 nerve root damage may have a connection with the large drift of spinal cord.关键词
C5 神经根麻痹/重建生理曲度/椎管成形术/脊髓漂移Key words
C5 nerve root palsy/reconstructed physiological curvature/spinal canal plasty/spinal cord drift分类
医药卫生引用本文复制引用
肖善富,张喜善,李平,董桂一..单开门椎管扩大成形术后颈椎曲度与C5神经根麻痹的关系[J].临床骨科杂志,2016,19(4):395-399,5.
