两种颈后路手术治疗多节段脊髓型颈椎病术后C_5神经根麻痹的效果比较

The comparison of C_5 palsy after two posterior cervical operations on multilevel cervical spondylotic myelopathy

目的比较两种颈后路手术治疗多节段脊髓型颈椎病术后C5神经根麻痹的发生率,并分析其可能的发生原因。方法选择2009年6月~2013年6月西京医院收治的245例多节段（≥3个）脊髓型颈椎病患者,分别采用改良单开门椎板成形术（A组,118例）及椎板减压融合内固定术（B组,127例）治疗。回顾性比较分析两组的手术时间、术中出血量、术前及术后神经功能恢复情况[采用日本骨科协会17分评分法（JOA）]、颈椎曲率指数（CCI）以及术后C5神经根麻痹发生情况。结果两组手术时间、术中出血量比较,差异无统计学意义（P〉0.05）。两组术前JOA评分、CCI相比较,差异无统计学意义（P〉0.05）;两组术后1年JOA评分与术前比较,差异有高度统计学意义（P〈0.01）,CCI与术前比较,差异无统计学意义（P〉0.05）。A组术后1年改善率为（67.82±13.35）%,B组术后1年改善率为（68.25±14.36）%,两组比较差异无统计学意义（P〉0.05）。术后6个月A组脊髓漂移距离低于B组,发生C5神经根麻痹者脊髓漂移距离高于未发生者,差异均有高度统计学意义（P〈0.01）,后纵韧带骨化症患者与无后纵韧带骨化症患者脊髓漂移距离差异无统计学意义（P〉0.05）。术后A、B两组C5神经根麻痹发生率分别为2.54%和13.39%,两组比较差异有高度统计学意义（P〈0.01）。结论两种颈后路手术治疗多节段脊髓型颈椎病时临床疗效相似,但是改良单开门椎板成形术后C5神经根麻痹的发生率明显低于椎板减压融合内固定术,椎板减压融合内固定术与后纵韧带骨化症可能为术后发生C5神经根麻痹的危险因素。

Objective To evaluate and compare the incidence of C5 palsy after two posterior cervical operations on multilevel cervical spondylotic myelopathy and the possible reasons. Methods From June 2009 to June 2013, in Xijing Hospital, 245 patients with multilevel cervical myelopathy （≥ 3 segments） were selected, 118 cases were treated with modified cervical open-door laminoplasty （group A）, 127 cases treated with cervical laminectomy and instrumented fu- sion （group B）. The operation time and intraoperative blood loss during operation, improvement of neurological function [17 score Japanese Orthopaedic Association （JOA）], cervical curvature index （CCI）, the incidence of C5 pasly were ret- rospectively analyzed and evaluated. Results The operative time and blood loss of two groups were compared, the differences were not statistically signifieant （P≥ 0.05）. JOA scores, CCI of two groups before operation were compared, the differences were not statistically significant （P 〉 0.05）; JOA scores at one year after operation of two groups were compared with before the operation, the differences were statistically significant （P 〈 0.01）, CCI of two groups were eom-pared with before the operation, the differences were not statistically significant （P 〉 0.05）. JOA improvement rate of group A was （67.82±13.35）%, group B was （68.25±14.36）%, the difference was not statistically significant （P 〉 0.05）. The distance of posterior shifting of spinal cord of group A less than group B at 6 months after operation, the distance of posterior shifting of spinal cord with C5 pasly greater than without C5 palsy, the differences were statistically significant （P 〈 0.01）. There was no signif- icant differences in the distance of posterior shifting of spinal cord with ossification of the posterior longitudinal ligament （OPLL） and without OPLL. The incidence of C5 nerve root palsy were 2.54% in group A and 13.39% in group B, the difference was statistically significant （P 〈 0.01）. Conclusion Both methods can effectively treat the multilevel mervical myelopathy with similar clinical efficacy. The incidence of C5 palsy after modified cervical open-door laminoplasty less than cervical laminectomy and instrumented fusion. Cervical laminectomy and instrumented fusion and OPLL may be the risk factors of C5 palsy.