颈椎管扩大成形椎间孔切开减压治疗颈神经根病

TREATMENT OF CERVICAL RADICULOPATHY BY LAMINOPLASTY AND FORAMINOTOMY

目的 评价颈椎管扩大成形椎间孔切开减压手术在治疗颈神经根病中的作用。 方法 1996年～2 0 0 0年治疗 2 9例有颈神经根压迫症状患者 ,其中男 16例 ,女 13例 ;年龄 38～ 72岁 ,平均 5 9岁。引起椎间孔狭窄的原因 :椎间盘脱出、钩椎关节骨赘形成、椎管狭窄 +黄韧带肥厚和关节突增生。最常受累的椎间孔为 C5、6 、C6、7。主要表现为双上肢感觉减退、肌力下降和反射减弱。手术为椎管扩大成形椎间孔切开减压 ,其中 度减压 13例 (次 ) , 度减压 2 1例(次 )。 结果 术后随访 15～ 2 9个月 ,平均 2 2个月。感觉减弱最先恢复 ,效果最为理想 ;其次为肌力恢复 ,腱反射恢复最慢 ,效果也最差。术后效果评价 :优 2 4例 ;良 4例 ;一般 1例。 结论 对合并有椎间孔狭窄的颈椎病患者 。

Objective To evaluate the results of laminoplasty and foraminotomy in treatment of cervical radiculopathy. Methods Of 29 patients, there were 16 males and 13 females, aged 38 to 72 years with an average of 59 years. The reasons of intervertebral foramen stenosis were:prolapse of intervertebral disc, osteophyte formation of Luschka joint, spinal canal stenosis combined with thickness of flavum ligmentum and facet joint hypertrophy. The most frequently affected intervertebral foramen were C 5,6 and C 6,7 . The most significant symptoms after impairment of nerve root were reduced sensation, muscle weakness and diminished reflexes. On the basis of laminoplasty, the foraminotomy was performed on the stenotic foramen, including grade Ⅰ decompression on 13 occasions, degree Ⅱ on 21 occasions; and double level decompressions were performed on 5 patients. Results After operation, reduced sensation was recovered most significantly and quickly, and the recovery of muscle weakness followed, while the recovery of diminished reflexes was the slowest and worst. In the followed up patients, the percentage of excellent and good results was 97%.Conclusion In the cervical spondylotic patients who also have foraminar stenosis, performing laminoplasty with foraminotomy can get good results. If the indication are chosen properly, it can be used widely in clinic.