颈椎椎板切除侧块螺钉内固定术后C5神经根麻痹的临床分析

Clinical Analysis of C5 Nerve Root Palsy after Cervical Laminoplasty with Lateral Mass Screw Fixation

目的分析颈椎椎板切除侧块螺钉内固定术后C5神经根麻痹的发病原因及与颈椎曲度变化、脊髓后移的关系。方法回顾分析2011—2013年采用颈椎椎板切除侧块螺钉内固定术治疗的脊髓型颈椎病患者74例,术后出现C5神经根麻痹的患者11例设定为A组,其余63例患者设为B组。术前、术后均行MR、CT及CR明确诊断,行JOA评分评定神经功能并计算改善率,以Ishihara法测定颈椎曲度指数(cervical curvatureindex,CCI),测定C2-7Cobb角计算颈椎曲度变化量,MR矢状位测量脊髓后移量等。所有患者随访1年以上。结果两组患者在一般情况、术前JOA评分、CCI比较差异均无统计学意义(P>0.05)。末次随访时两组JOA评分较术前明显改善(P<0.05),两组间JOA改善率比较差异无统计学意义(P>0.05)。术后A组CCI、曲度变化量、脊髓后移量大于B组,差异有统计学意义(P<0.05)。JOA评分改善量和术后CCI之间、JOA评分改善量和脊髓后移量之间无相关性(P<0.05)。结论颈椎椎板切除侧块螺钉固定术后C5神经根麻痹有较高的发生率(14.9%),术中应避免过度矫正后凸,可行预防性切开椎间孔。术后颈椎曲度及脊髓后移与神经功能恢复无相关性。

Objective To analyze the reasons for the occurrence of C5 nerve root palsy after cervical laminectomy with lateral mass screw fixation,and its correlation with the variance of cervical curvature and posterior shifting of spinal cord for C5 nerve root palsy after cervical laminectomy with lateral mass screw fixation. Methods 74 patients from 2011 to 2013 with cervical myelopathy were treated by cervical laminectomy with lateral mass screw fixation,and divided into Group A（ with C5 nerve root palsy,11 cases） and Group B（ without C5 nerve palsy,63 cases）. Magnetic resonance（ MR）,computerized tomography（ CT）,and Computed Radiography（ CR） were obtained before and after operation. The Japanese Orthopaedic Association（ JOA） score was used for neurological assessment and recovery rate（ RR）. Cervical curvature index（ CCI） was measured by Ishihara method,C2- 7Cobb angle was measured to calculate the cervical curvature variation,the posterior shifting of spinal cord（ PSSC） was measured through MR saggital. All patients were observed with follow- up studies for more than 12 months. Results No significant difference was found in general data of patients,JOA scores before operation or CCI（ P〉0. 05）. At the time of the latest follow- up after operation,JOA scores of the two groups were remarkably improved compared with those before operation（ P〈0. 05）. There was no statistical significant difference in JOA recovery rates between two groups before operation（ P〉0. 05）. After operation,CCI,the change of cervical curvature and PSSC of group A were greater than that of group B,and the difference was statistically significant（ P〈0. 05）. JOA score improvement was not correlated with CCI or PSSC after operation（ P〈0. 05）. Conclusion There is a high incidence（ 14. 9%） of C5 nerve root palsy after laminectomy with lateral mass screw fixation,over- correction of kyphosis should be avoided,and preventive incision intervertebral foramen is feasible. Nerve function recovery is not correlated with cervical curvature index and posterior shifting of spinal cord.