近端肌萎缩型颈椎病11例的诊治分析

Diagnosis and treatment of 11 patients with cevical spondylotic amyotrophy

目的:探讨近端肌萎缩型颈椎病的临床特点、治疗方法及临床效果。方法:回顾性分析2016年9月至2020年12月治疗的11例近端肌萎缩型颈椎病患者,其中男7例,女4例,年龄38~68岁。分析其临床症状特点、MRI及神经电生理表现,分别采用保守治疗或颈椎前路减压融合手术进行治疗,治疗前后采用徒手肌力评定方法(manual muscle test,MMT)对患者进行疗效评价,同时随访患者满意度。结果:所有患者获得随访,时间6~19个月。11例均为单侧发病,主要表现以三角肌、冈上肌、冈下肌萎缩为主,早期可以伴有同侧颈肩痛;MRI显示以C_(4,5)、C_(5,6)节段病变多见,神经电生理检查表现为受累肌肉失神经支配,患侧支配神经复合肌肉动作电位(compound muscle action potential,C MAP)波幅较健侧降低。所有手术患者获得骨性融合,1例行颈椎体次切减压融合术(anterior cervical corpectomy and fusion,ACCF)术后出现对侧C_(5)神经根麻痹,经对症治疗10周后完全恢复。治疗后12个月时根据MMT疗效评估:保守治疗3例,优2例,良1例;手术治疗8例,优3例,良4例,可1例。结论:近端肌萎缩型颈椎病发病率低,表现为单侧近端肌肉萎缩,早期可以伴有同侧颈肩痛,结合MRI、神经电生理检查可以减少误诊。在发病早期尤其是髓核脱出导致神经压迫的可以采取保守治疗,当保守治疗无效或疼痛不能耐受时建议行前路减压手术,整体疗效满意。

Objective To explore clinical features,treatment methods and clinical effects of cervical spondylosis with proximal muscular atrophy Methods Eleven patients with proximal-type cervical spondylotic amyotrophy were retrospectively studied from September 2016 to November 2020,including 7 males and 4 females,aged 38 to 68 years old.Clinical symptoms,MRI and neuroelectrophysiological manifestations were analyzed,and patients were treated with conservative treatment or anterior cervical decompression fusion surgery respectively.The efficacy was evaluated by manual muscle test(MMT) before and after treatment,and patients' satisfaction was followed up at the same time.Results All patients were followed up for 6 to 19months.All 11 patients were unilateral,mainly manifested by atrophy of deltoid muscle,supraspinatus muscle and infraspinatus muscle,and may be accompanied by ipsilateral neck and shoulder pain at early stage.MRI showed lesions at C_4,_5,C_(5,6) segments were more common.Electrophysiological examination showed the affected muscle was denervated,and amplitude of compound muscle action potential(CMAP) of innervated nerve on the affected side was lower than that on the healthy side.All patients were obtained bone fusion.One patient who were underwent anterior cervical corpectomy and fusion(ACCF) occurred developed contralateral C_(5) nerve root paralysis after operation,which recovered completely after 10 weeks of symptomatic treatment.At 12 months after operation,the efficacy was evaluated according to MMT,3 patients were treated conservatively,2 patients excellent and 1 good;in 8 patients treated by operation,3 patients were excellent,4 good,and 1 moderate.Conclusion The incidence of cervical spondylosis with proximal muscular atrophy is low,which is manifested as unilateral proximal muscle atrophy and may be accompanied by ipsilateral neck and shoulder pain in the early stage.Combined with MRI and neuroelectrophysiological examination,misdiagnosis could be reduced.In the early stage of disease,especially in the case of nucleus pulposus protrusion leading to nerve compression,conservative treatment could be taken.When the conservative treatment is ineffective or the pain cannot be tolerated,anterior decompression surgery is recommended,and the overall effect is satisfactory.