摘要
目的:探讨颈椎单开门椎板成形术后出现上肢节段性运动麻痹的临床和影像学特点及其预后。方法:2004年5月～2007年1月行颈椎单开门椎板成形术后出现6例上肢节段性运动麻痹并发症患者,回顾总结患者的临床资料,分析此并发症的临床特征、颈椎MRIT2加权像所表现的影像学特点。1例患者术后即刻进行了C3～C7椎板切除术,6例均行脱水、抗炎及营养神经药物治疗,随访观察该并发症的恢复情况。结果:行单开门颈椎板成形术的481例患者中6例发生上肢节段性运动麻痹并发症,均发生于术后48h内,表现为上肢多个肌肉的肌力下降(肌力3级5例,肌力0级1例),均为单侧上肢发生。影像学表现为术后颈椎MRIT2加权像出现新发的脊髓高信号区(HIZ),HIZ节段与运动麻痹节段相一致。随访12～36个月,平均18个月,3例患者肌力完全恢复,2例患者肌力分别从0级和3级恢复至4级,1例肌力3级患者肌力下降为0级并出现手内在肌萎缩。结论:单开门颈椎板成形术后可出现上肢节段性运动麻痹的并发症,多为单侧上肢发生,术后患者的颈椎MRIT2加权像出现新发的HIZ改变,完全恢复率较低。
Objective ：To explore the clinical and imaging features,and prognosis of upper extremity segmental motor paralysis after cervical Expansive open-door laminoplasty.Method：Clinical materials and imaging features in magnetic resonance of T2-weighted of 6 patients undergoing cervical expansive open-door laminoplasty followed by upper extremity segmental motor paralysis between May 2004 and January 2007 were reviewed retrospectively.0f these 6 patients with upper extremity segmental motor paralysis,one underwent posterior laminectomy （C3-C7） immediately.Beside this,all six patients underwent dehydration,anti-inflammatory and nerve neurotrophic drugs therapy and followed up.Result：Upper extremity segmental motor paralysis occurred in 6 of 481 patients undergoing cervical expansive open-door laminoplasty within 48 hours after operation, which was featured as motor weakness of muhiple muscles with muscle strength of grade 3 in 5 cases and grade 0 in 1 cases,while all segmental motor paralysis occurred unilaterallly.Postoperative magnetic resonance imaging showed the presence of a T2-weighted high intensity zone in the spinal cord of all the patients with the site of HIZ correspondence to the paralysis level.The mean follow-up was 18 months （range, 12 to 36 months）,at final follow-up,3 patients had muscle strength improved completely and 2 patients up to fourth grade,however 1 patien had muscle strength down to zero and complicated with atrophy of multiple hand innermuscles.Conclusion：Upper extremity segmental motor paralysis secondary to cervical expansive open-door laminoplasty predominantly occurs unilaterally,which show the presence of a T2-weighted HIZ in spinal cord in postoperative imaging and has lower complete recovery rate.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2009年第1期30-33,共4页
Chinese Journal of Spine and Spinal Cord
关键词
颈椎
椎板成形术
并发症
上肢运动麻痹
髓内高信号区
Cervical spine
Laminoplasty
Complications
Upper extremity segmental motor paralysis
High intensity zone
