伴上肢局部水肿的颈椎病与颈椎减压术的关系

Relationship between the cervical vertebra sickness with partial upper limb edema and the operation to reduce the cervical vertebra pressure

[目的]探讨伴有上肢局部水肿的颈椎病患者的发病机理和与手术颈椎减压的关系。[方法]总结分析4 a来收治的10例伴有上肢局部水肿的颈椎病人,其中脊髓型颈椎病7例,神经根型颈椎病2例,后纵韧带骨化型1例,7例行前路椎体次全切减压植骨内固定,1例行前路椎体次全切+单间隙间盘摘除植骨内固定,2例行后路减压植骨内固定,术后观察患者水肿消退情况。[结果]10例病人上肢局部水肿不同程度消退,前路手术者较后路手术者消退快。[结论]颈椎病患者上肢水肿的发生与颈交感神经受激惹有关,通过前路或后路颈椎管减压,去除颈椎不稳、椎间盘突出、骨赘等交感神经受激惹因素,水肿可逐步消退。

[ Objective] To discuss the relationship between partial upper limb edema in the cervical spondylosis patients and the decompression operation. [ Method ] Ten cervical spondylosis cases with partial upper limb edema were reviewed, ineluding 7 cases of cervical spondylotic myelopathy, 2 cases of cervical radiculopathy and 1 case of OPLL （ossification of the posterior longitudinal ligament）. Seven cases were treated with subtotal vertebrectomy and anterior internal fixation, one with subtotal vertebrectomy and anterior discectomy, 2 cases with posterior decompression and fusion. All the patients were available for follow-up to evaluate the decay of the edema. [ Result] All the 10 patients＇ edema disappeared with the duration from one day to over half a year. The treatment of anterior surgery made patients＇ edema disappear quicker than that of posterior surgery. [ Conclusion] The occurrence of the upper limb edema in the cervical spondylosis patients is related to do with the irritated sympathetic nerve. The edema can be reduced in short term after the decompression operation.