颈椎后路减压并发C_5神经根麻痹的病因分析

Analysis of C_5 palsy with C4/5 foraminotomy after posterior cervical decompression surgery

目的探讨颈椎后路全板减压术中行C_(4～5)神经根孔扩大减压预防术后C_5神经根麻痹的有效性及其病因分析。方法回顾性分析2011年1月—2015年12月收治的127例行颈后路全板减压侧块内固定术的患者资料,男62例,女65例。其中,A组61例(男28例,女33例)行后路C^(3～7)全椎板减压固定,B组66例(男34例,女32例)后路C_(3～7)减压固定的同时行C_(4～5)双侧椎间孔扩大减压术。回顾性分析2组患者术后C_5神经根麻痹的发生率和脊髓功能改善率差异。结果 2组组内手术前、后JOA评分及颈椎曲度指数(CCI)变化的比较,差异有统计学意义。术后出现C_5神经根麻痹症状A组11例(18.03%),B组3例(4.55%),2组发生率差异有统计学意义(P=0.022)。结论颈椎后路全板减压能有效改善脊髓功能,C_5神经根通道扩大减压能有效预防术后发生C_5神经根麻痹。

Objective To evaluate the effects of C4-5partial foraminotomy on reducing the occurrence of C5palsy after posterior cervical decompression surgery.Methods A total of127patients(male62,female65)underwent the cervical decompression surgery with lateral cervical mass screw insertion between January2011and December2015were retrospectively analyzed.In these patients sixty-one cases(Group A)underwent the posterior laminectomy with lateral cervical mass screw insertion,while66cases(Group B)received posterior laminectomy with lateral cervical mass screw insertion,combined with partial C4/5foraminotomy at C4-5level.The clinical data,radiographic parameters and the occurrence of C5palsy were assessed in two groups of patients.Results There was no significant difference in JOA recovery rate and change of cervical curvature index between preoperation and postoperation in each group(P>0.05).Postoperative C5palsy occurred in11cases(18.03%)in group A and3cases(4.05%)in group B.The difference in the incidence of C5palsy was significant between the two groups(P=0.022).Conclusion The cervical decompression surgery can improve the function of the spinal cord effectively.C4-5partial foraminotomy after cervical decompression surgery is effective for preventing C5palsy.