颈椎单开门椎管成形术后C5神经根麻痹的致病因素分析

Analysis of pathogenic factors for C5 palsy after open-door laminoplasty

目的探讨颈椎单开门椎管成形术后发生C5神经根麻痹的危险因素。方法回顾性分析我院2009年1月—2012年12月行颈椎单开门颈椎管成形术治疗的脊髓型颈椎病患者254例,按术后是否发生C5神经根麻痹分为麻痹组20例和无麻痹组234例。比较2组间后纵韧带骨化、椎间孔狭窄、脊髓内缺血信号、术后颈椎曲度指数（CCI）改变、颈椎椎板开门角度以及脊髓后移等因素与C5神经根麻痹发生的关系,分析可能影响C5神经根麻痹发生的致病因素。结果全部病例获得随访,平均（24.9±2.6）个月。麻痹组术后颈椎CCI、开门角度、脊髓后移距离大于无麻痹组（P〈0.05）。2组脊髓内缺血信号、后纵韧带骨化、椎间孔狭窄方面的差异无统计学意义（P〉0.05）。多因素Logistic回归分析显示,开门角度、脊髓后移、颈椎术后CCI是术后发生C5神经根麻痹的致病因素[OR（95%CI）分别为2.035（1.684~2.359）、3.542（2.465~9.254）、9.126（4.425~17.273）]。结论在术中开门角度大、术后CCI较大以及术后脊髓后移较大是引起颈椎单开门椎管成形术后发生C5神经根麻痹的危险因素。

Objective To discuss the risk factors of C5 never palsy incidence after cervical open-door laminoplasty. Methods This study involved 254 patients with cervical spondylotic myelopathy, who underwent expansive open-door lam- inoplasty in our hospital between January 2009 and December 2012. Patients were divided into two groups according to the incidence of C5 palsy after operation. Group A included 20 patients with C5 palsy and group B included 234 cases without C5 palsy. The risk factors for postoperative C5 palsy were compared between two groups. The factors may affect the inci- dence of C5 palsy were analyze. Results All cases received follow-up with an average follow-up time （24.9±2.6） months. Values of cervical curvature index （CCI）, lamina open angles and spinal cord shift were significantly greater in group A than those of group B （P 〈 0.05）. There were no significant differences in preoperative intramedullary high signal, ossification of posterior longitudinal ligament and intervertebral foramen stenosis between two groups （P 〉 0.05）. Results of Logistic regres- sion analysis of multiple factors showed that lamina open angles, the pathogenic factors of C5 palsy included the spinal cord shift and postoperative CCI [0R（95%CI）：2.035（1.684-2.359）, 3.542 （2.465-9.254） and 9.126（4.425-17.273）. Conclusion The angle of open door too large, CCI and spinal cord shift are risk factors for postoperative C5 palsy.