颈椎后路内固定术后神经根麻痹和融合节段曲度变化关系的临床研究

Clinical research on the relationship between the cervical nerve root palsy after posterior internal fixation and the change of cervical curvature

目的观察颈椎后路全椎板切除减压内固定术融合节段的曲度变化,探讨其与颈神经根麻痹症状的关系。方法随访91例颈椎病后路手术患者,所有患者拍摄颈椎中立侧位X线片,测量颈椎整体曲度,及CCI指数。根据是否存在神经根麻痹症状,对患者分成两组进行观察、分类及统计学分析。结果颈椎后路椎板切除减压内固定术的患者生理曲度较术前减少,同生理曲度好转或无变化的患者相比,术后生理曲度变直的患者颈椎神经根麻痹的发生率较高,按CCI指数的变化评价,CCI指数变化率增大,发生神经根麻痹的可能性会明显增加。结论研究表明颈椎后路术后生理弧度的变化,是引起C5神经根麻痹的可能原因之一,CCI指数的变化对于预测颈椎神经根麻痹的发生有一定的意义。

Objective To observe all changes of the curvature after posterior vertebral lamina resection decompression and internal fixation , discusses its relationship with the symptoms of cervical nerve root palsy . Methods 91 cases of cervical spondylosis patients who received posterior internal fixation on the cervical were followed-up.All the patients were done X-ray films on neutral side of cervical spine , measured the cervical curvature and CCI index .The patients were divided into two groups to make the observation , classification and statistical analysis according to whether they have nerve root palsy symptoms .Results Physiological curvature of the patients who received posterior vertebral plate decompression and internal fixation were decreased compared to this preoperative .Compared to the patients whose physiological curvature improved or no change , incidence of cervical nerve root palsy increased in patients whose postoperative physiological curvature straighten . The possibility of nerve root palsy increased as CCI index change rate increased . Conclusions This study demonstrate that the change of physiological radian after the posterior cervical spine surgery , is one of the possible causes which induce C5 nerve root palsy, the change of CCI index has certain significance in predicting the occurrence of cervical nerve root palsy .