颈椎病引起膈肌功能障碍病理机制及临床诊疗的研究进展

Research progress on pathological mechanism,clinical diagnosis and treatment of diaphragm dysfunction caused by cervical spondylosis

目的总结颈椎病引起膈肌功能障碍的病理机制及临床诊疗方面的研究进展。方法以"颈椎病""膈肌功能障碍""膈肌痉挛""cervical spondylosis""diaphragm dysfunction""diaphragmatic paralysis"等为关键词, 分别在中国知网、中华医学期刊全文数据库、万方数据库、PubMed等中英文数据库中, 检索1980年1月—2024年1月发表的、与颈椎病引起的膈肌功能障碍相关的文献51篇, 剔除内容不符、质量较低、重复研究的文献, 最终纳入24篇文献进行系统分析, 重点总结了颈椎病引起膈肌功能障碍的解剖基础和病理机制, 以及该病的临床表现、诊断、治疗及预后等方面的研究成果。结果颈椎病引起膈肌功能障碍主要由膈神经损伤或膈神经起源的神经根损伤造成, 膈神经核、腹侧神经根受压迫, 脊髓前动脉受压导致缺血性改变是造成膈肌功能障碍的相关机制。颈椎病引起膈肌功能障碍的临床表现通常并不明显, 当累及膈神经双侧的大部分时临床表现才会明显, 患者主要临床表现为呼吸障碍合并脊髓型颈椎病及神经根型颈椎病的症状, 少数患者在支配膈肌的神经根受到孤立机械压迫的情况下, 也可能没有神经症状学表现。临床上多采用胸部X线/CT、多普勒超声、肺功能等检查进行诊断。对无症状或症状不明显的患者可以采取保守治疗;对于症状较重的患者也可以进行颈椎前路或后路减压手术, 手术方式、手术入路及减压范围主要取决于患者的实际情况。结论颈椎病引起膈肌功能障碍的病例临床少见, 易出现误诊漏诊。对退行性颈椎病伴有不同程度呼吸功能减退的患者, 应在完善专科检查的同时评估膈神经与膈肌功能, 早期诊治, 使患者从早期的干预中受益。

Objective This study aimed to summarize the research progress on the pathological mechanism,clinical diagnosis and treatment of diaphragm dysfunction caused by cervical spondylosis.Methods With"颈椎病""膈肌功能障碍""膈肌痉挛""cervical spondylosis""diaphragm dysfunction"and"diaphragmatic paralysis"as key words,51 articles related to diaphragm dysfunction caused by cervical spondylosis were searched in the China Knowledge Network,Chinese Medical Journal Full-text Database,Wanfang Database,PubMed,and other Chinese and English databases from January 1980 to January 2024,and 24 articles with inconsistent content,low quality,and repeated research were excluded.The related anatomy,pathological mechanism,clinical manifestation,diagnosis,treatment,and prognosis of diaphragm dysfunction caused by cervical spondylosis were summarized and discussed.Results The diaphragm dysfunction caused by cervical spondylosis is mainly caused by the injury of phrenic nerve or the nerve root of phrenic nerve origin.The compression of phrenic nucleus and ventral nerve root and the ischemic changes caused by the compression of anterior spinal artery are the related mechanisms of diaphragm dysfunction.The clinical manifestations of diaphragmatic dysfunction caused by cervical spondylosis are usually not obvious.They become obvious when only most of the bilateral phrenic nerves are affected.Most patients show symptoms of dyspnea complicated with cervical spondylotic myelopathy and radiculopathy.A few patients may not have neurological symptoms when the nerve root innervating the phrenic nerve is mechanically compressed.Chest X-ray/CT,Doppler ultrasound,pulmonary function,and other examinations can be used for diagnosis.Conservative treatment can be performed for patients without symptoms or with mild symptoms.Anterior or posterior cervical decompression surgery can be performed for patients with severe symptoms.The surgical method,surgical approach,and decompression range mainly depend on the actual situation of the patient.Conclusion Clinical cases of diaphragm dysfunction caused by cervical spondylosis are rare and prone to misdiagnosis and missed diagnosis.For patients with degenerative cervical spondylosis with different degrees of respiratory dysfunction,the function of phrenic nerve and diaphragm should be evaluated while improving specialist examination and early diagnosis and treatment so that patients can benefit from early intervention.