颈椎前路术后颈5神经根麻痹相关风险分析

Analysis of Correlative Risk Factors for C5 Palsy after Anterior Cervical Decompression and Fusion

目的:探讨颈椎前路减压融合手术后颈5神经根麻痹相关危险因素,用以指导、评估患者预后。方法:回顾性分析我科2013年1月至2014年12月因颈椎病住院并接受前路减压手术的96例患者的临床资料。采集术前患者基本资料,如年龄、性别、病程、以及术前JOA评分等指标。将术后出现三角肌肌力降低1级以上者诊断为颈5神经根麻痹。以患者术后是否出现颈5神经根麻痹为标准,将患者分为A组(颈5神经根麻痹组)、B组(非颈5神经根麻痹组)。分别测量并记录手术前后2组颈椎生理弧度变化、术前C4/5椎间孔前后径、椎体撑开高度、术前颈椎MRI T2像在C4/5节段上是否存在高信号等影像学参数。采集2组患者手术节段数、手术时间、术中出血量等指标。采用Logistic回归分析,判断与颈5神经根麻痹有关的风险因素。结果:术后9例出现颈5神经根麻痹症状。2组颈椎生理曲度的变化、椎间孔前后径和减压节段数差异有统计学意义(P<0.05)。通过Logistic回归分析显示,颈椎生理曲度的变化、减压节段数和椎间孔前后径是颈5神经根麻痹的危险因素。结论:对于临床上接受颈椎前路减压手术的患者,过度矫正患者颈椎生理弧度、术前患者椎间孔狭窄以及减压节段数是颈5神经根麻痹发生的危险因素。合理的减压手术是预防颈5神经根麻痹的关键。

Objective： To identify the correlative risk factors of C5 palsy after anterior cervical decompression and fusion （ACDF） . Methods： From Jan 2013 to Dec 2014, 96 patients who had been diagnosed cervical spondylotic myelopathy and underwent ACDF were selected. C5 palsy was defined as deterioration in muscle strength of the deltoid by at least one grade on manual motor testing. The patients were divided into two groups： one that had experienced C5 palsy （group A） and the other one had not （group B）. Age, gender, duration of the disease, No. of surgical levels, cervical curvature correction, anterior-posterior diameter of the C4/5 foramen, intervertebral height variation and high signal intensity zone （HIZ） of spinal cord in T2-weighted MRI at C4/5 were measured and evaluated. The risk factors of C5 palsy were detected by Logistic regression analysis. Results ： All operations went well. And 9 cases experienced C5 palsy after surgery. There were no statistic differences in age, gender, duration of the disease, intraoperative blood loss, preoperative of JOA score and HIZ of spinal cord in T2- weighted MRI at C4/5. However cervical curvature correction, anterior-posterior diameter of the C4/5 foramen, intervertebral height variation had significant differences between the two groups. Logistic regression analysis revealed that cervical curvature, diameter of the C4/5 foramen and No. of surgical levels were the key risk factors for the incidence of C5 palsy. Conehlsions： For patients underwent ACDF, No. of surgical levels, greater cervical curvature correction and narrow diameter of the C4/5 foramen are correlative risk factors for C5 palsy. Thus proper decompression plan should be made.