颈前路减压内固定术后C_5神经根损伤的原因及预防

The causes and prevention of C_5 nerve root palsy after anterior cervical decompression and fusion

目的 ：对颈前路减压内固定术后C_5神经根损伤原因进行分析,并探讨预防的手段。方法：自2005年1月至2015年12月进行颈前路减压及融合手术310例,对其中9例术后出现C_5神经根损伤的患者进行回顾性分析,男8例,女1例;年龄51~84岁,平均64岁。内固定椎间融合手术节段：单节段为2例,双节段6例,3节段1例。单纯三角肌无力及疼痛麻木7例,三角肌及肱二头肌同时无力及疼痛麻木2例。肌力0级1例,1级3例,2级4例,3级1例。结果：9例患者术后随访均超过12个月,最长为24个月,平均14个月。其中7例肌力恢复到4~5级。术后恢复时间与损伤程度成正比,术后肌力在2级以上的患者3周之内有明显改善。JOA评分术前10.89±1.89,术后发生C_5神经根麻痹时8.92±1.91,末次随访时14.48±2.10,差异有统计学意义（P〈0.05）。结论：颈前路内固定术后C_5神经根损伤的原因较为复杂,如果不存在严重碾挫伤及离断伤,多数患者可以获得满意的恢复。严格把握手术适应证,正确选择手术节段,操作准确轻柔,控制术中椎间隙撑开的幅度及椎体次全切的宽度等是预防此并发症的要素。

Objective：To analyze the causes of muscular paralysis due to C_5 nerve root injury after anterior cervical decompression and fusion（ACDF） and explore its prevention way. Methods：From January 2005 to December 2015,310 patients underwent ACDF in our hospital. Of them,9 cases occurred muscular paralysis due to C_5 nerve root injury after operation.The clinical data of 9 patients were retrospectively analyzed. There were 8 males and 1 female,aged from 51 to 84 years with an average of 64 years. Two cases underwent internal fixation and intervertebral fusion with one segment,6 cases with two segments,1 case with three segments. Simple deltoid muscle weakness,pain,numbness happened in 7 cases,simultaneously biceps brachii muscle weakness,pain,numbness in 2 cases. Muscle strength was 0 grade in 1 case,1 grade in 3 cases,2 grades in 4 cases,3 grades in 1 case. Results：The follow-up time of 9 patients was more than 12 months and the longest was 24 months with an average of 14 months. Muscle strength of 7 patients recovered to 4-5 grades. Recovering time after operation was directly proportional to the degree of injury,those patients with muscle strength level more than 2,usually could have significant improvement within 3 weeks. The JOA score improved from 10.89±1.89 preoperatively to 8.92±1.91 postoperative C_5 nerve root palsy to 14.48±2.10 at final follow up,with significant difference（P〈0.05）. Conclusion：More complicated factors result in C_5 nerve root injury after ACDF. Except those suffered severe grinding contusion and amputation,most of the patients can get satisfactory prognosis. Strict control of the operation indication,selection of the right surgical segment with accurate manipulation,control of the distraction of intervertebral space and the width of the multilevel anterior cervical corpectomy,are main methods to prevent the complication.