摘要
目的探讨颈椎后纵韧带骨化患者后路减压术后发生C5神经根麻痹的临床特点、病理机制及其危险因素。方法2000年1月至2005年8月，采用后路椎板切除减压及侧块钉棒（板）系统固定治疗颈椎后纵韧带骨化患者49例，男35例，女14例；年龄39-75岁，平均53．7岁。在术后6-64h，9例患者发生C5神经根麻痹，表现为患肢三角肌和（或）肱二头肌肌力下降，伴有肩部及上臂外侧感觉减退或消失。比较麻痹患者与非麻痹患者侧位X线片上颈椎前凸角度的变化、C4-5水平CT横断面上椎管狭窄率和MRI T2加权像脊髓高信号区改变的差异。结果9例C5神经根麻痹患者均接受保守治疗，治疗措施包括功能锻炼、口服药物及高压氧治疗。随访1-4年，平均2．2年，9例患者肌力均恢复至3-4级。麻痹患者颈椎曲度矫正值（12．5°±3．0°）大于非麻痹患者（1．9°±1．1°），差异有统计学意义（P=0．04）；麻痹患者椎管狭窄率（62．6％±6．8％）高于非麻痹患者（35．1％±5．4％），但差异无统计学意义（P=0．12）；麻痹患者术后仅有3例脊髓高信号区范围扩大而超过原椎间隙水平，与非麻痹患者脊髓高信号区改变的比例差异无统计学意义（P=0．32）。结论C5神经根麻痹在颈椎后纵韧带骨化患者中具有较高发生率，后路手术中应适度矫正颈椎前凸角度。
Objective To discuss clinical characteristic, pathologic mechanism and risk factors of C5 palsy after cervical posterior decompression in the patients with cervical ossification of posterior longitudinal ligament （OPLL）. Methods Between January 2000 and August 2005, 49 patients with OPLL underwent posterior cervical laminectomy and fixation with a system of lateral mass screws and rods （plates）. This series included 35 males and 14 females, and their age ranged 39-75 years, with an average of 53.7 years. At 6- 64 h postoperatively, 9 patients developed C5 palsy. They represented decrease in power of related deltoid and/or biceps muscles, associated with sensory deficit in shoulder and lateral area of upper arms. To compare the differences of cervical lordosis in lateral X-ray films, occupying rate of the spinal canal at C4-5 CT scans and high-signal intensity zone of spinal cord in T2 weighted MR images between palsy patients and non-palsy patients. Results All 9 patients with C5 palsy got conservative treatments, including functional exercises, drug administration and high-pressure oxygen therapy. After a follow-up period of 1-4 years （average, 2.2 years）, power of paralyzed muscles recovered to grade 3-4 in manual muscle testing. Amount of increased cervical lordosis in palsy patients （12.5°±3.0°） was significantly larger than that in non-palsy patients （1.9°± 1.1°）, the P value reach to 0.04; occupying rate of the spinal canal in palsy patients （62.6%±6.8%） was larger than that in non-palsy patients （35.1%±5.4%）, but the difference did not reach statistic significance （P= 0.12）; high-signal intensity zone in only 3 palsy patients was found to significantly expand to adjacent intervertebral levels, and the difference in comparison of signal changes with non-palsy patients did not reach statistic significance （P=0.32）. Conclusion The preliminary data of this study suggest a high incidence of C5 palsy in the patients with cervical OPLL, and a moderate increase of cervical lordosis in the posterior surgery for OPLL oatients should be advocated.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2007年第8期572-575,共4页
Chinese Journal of Orthopaedics
关键词
颈椎
骨化
后纵韧带
椎板切除术
神经根病
Cervical vertebrae
Ossification of posterior longitudinal ligament
Lamineetomy
Radiculopathy
