肌萎缩型颈椎病的临床分析

Surgical treatment of cervical spondylotic amyotrophy

目的探讨肌萎缩型颈椎病的临床特点和治疗。方法总结9例肌萎缩型颈椎病患者和15例同期手术的神经根型颈椎病、脊髓型颈椎病患者的临床表现、影像学和肌电图检查、治疗效果及预后。肌萎缩型颈椎病患者中7例行单纯椎间盘切除 cage 植入术,2例采用颈椎后路开门椎管减压、颈椎前路椎体次全切植骨钢板内固定术。15例脊髓型和神经根型颈椎病中12例行颈椎前路椎间盘切除 cage 植入术,3例行颈椎后路开门椎管减压、颈椎前路椎体次全切植骨钢板内固定术。结果 MRI 显示单节段-两节段颈椎间盘突出占77.7%(7/9),3节段及3节段以上颈椎间盘突出仅占22.2%(2/9)。肌电图显示所有病例均呈受累上肢肌肉的神经源性损害,所有病例均未显示胸锁乳突肌神经源性损害及舌肌纤颤电位。术后随访6～36个月,9例肌萎缩型颈椎病患者肌力均明显改善,术后6个月其中6例肌力由术前Ⅰ～Ⅱ级恢复至术后Ⅳ～Ⅴ级,改善率为75%～100%。2例肌力由术前Ⅲ级分别恢复至术后Ⅳ～Ⅴ级,改善率分别为50%和100%。1例(多节段)由术前Ⅰ级恢复至Ⅲ级,改善率为50%;8例术后随访超过12个月,7例恢复至Ⅴ级,改善率100%,1例恢复至Ⅳ级,改善率80%。同期手术的神经根型颈椎病和脊髓型颈椎病患者,术后随访12～36个月,15例患者肌力不同程度改善,术后6个月,患者肌力由术前Ⅱ～Ⅳ级恢复至术后Ⅲ～Ⅴ级,改善率为20%～100%,15例随访均超过12个月,11例恢复至Ⅴ级,改善率100%,3例恢复至Ⅳ级,改善率20%～50%,1例仍停留在3级,未改善。结论肌萎缩型颈椎病是一种临床少见的特殊类型颈椎病。其临床症状体征易与脊髓侧索硬化等神经元疾病混淆,MRI 和肌电图检查有助于确诊,其产生的机制可能与脊髓前角受压并伴有缺血性障碍有关,及时的手术减压治疗对肌萎缩恢复有明显帮助,单节段损害的手术预后好于多节段损害。

Objective To investigate the clinical characteristics and treatment of cervical spondylotic amyotrophy. Methods 9 cervical spondylotic amyotrophy patients and 15 cervical radiolopathy, myelopathy spondylosis patients were included in this study. Their clinical manifestation, MRI image results and treatment were analysised. Of 9 cervical spondylotic amyotrophy patients, 7 cases were done with cervical disectomy, 2 cases were done with combined cervical anterior and posterior operation; of 15 radiolopathy, myelopathy spondylosis patients, 12 cases were done with cervical disectomy, 3 cases were done with combined cervical anterior and posterior operation. Results Cervical spondylotic amyotrophy patients were followed up 6-36 months, muscle power of 9 patients were improved markedly, muscle power of 6 patients were improved from grade It preoperation to grade Ⅳ - Ⅴ postoperation after operation 6months, relief rate is 75%-100%, that of 2 patients were improved from grade Ⅲ preoperation to grade Ⅳ -Ⅴ postoperation, relief rate is 50% and 100% respectively, that of 1 patient （multiple segments） were improved from grade Ⅰ preoperation to grade Ⅲ postoperation, relief rate is 50% ; 8 patients were followed up over 12 months, muscle power of 7 patients were improved to grade Ⅴ, relief rate is 100% , that of 1 patient were improved to grade Ⅳ, relief rate is 80%. cervical radiolopathy, myelopathy spondylosis patients were followed up 12-36 months, muscle power of 15 patients were improved respectively, muscle power of 15 patients were improved from grade Ⅱ -Ⅳ preoperation to grade Ⅲ-Ⅴ postoperation after operation 6months, relief rate is 20%-100%, all 15 patients were followed up over 12 months, muscle power of 11 patients were improved to grade Ⅴ, relief rate is 100% , that of 3 patient were improved to grade Ⅳ, relief rate is 20% -50%, that of 1 case keep unchanged. Conclusion Cervical spondylotic amyotrophy is a rare type of cervical spondylotic disorder, it is easily misdiagnosed because it is confused with motor neuron disease. MRI and electromyography can help to diagnose. The mechanism of cervical spondylotic amyotrophy maybe is that compression of anterior horn of spinal cord or ischemic injury of spinal cord. Surgical treatment can help to improve muscle power, prognosis of single segment is better than that of multiple segments.