【摘要】 [目的]分析不同颈椎后路减压术后C5神经根麻痹的发生率及其可能的原因,探讨C4、5椎间孔减压对C5神经根麻痹的预防作用。[方法]将2005年6月~2012年5月行颈椎后路减压术的131例颈椎疾病患者纳入研究,男86例,女45例;平均年龄(58.3±10.9)岁。其中行椎管扩大成形术63例,行椎板切除减压术68例;此外,67例患者行单纯颈椎后路减压术(A组),64例患者接受颈椎后路减压术并双侧椎间孔减压术(B组)。对行椎管扩大成形术患者与行椎板切除减压内固定术患者术前术后的临床资料、术前影像学资料和C5神经根麻痹发生率进行评估,同时对A、B组术前术后的临床资料、影像学资料和C5神经根麻痹发生率进行统计学分析。[结果]随访12~54个月,平均(23.4±8.8)个月,131例患者中共有9例发生术后C5神经根麻痹,总体发生率为6.9%。行椎管扩大成形术患者中,3例发生C5神经根麻痹(4.8%);行椎板切除减压内固定术的患者中有6例发生C5神经根麻痹(8.8%)。两种术式C5神经根麻痹的发生率差异无统计学意义(P>0.05)。A组有8例患者发生C5神经根麻痹(11.9%),B组有1例患者发生C5神经根麻痹(1.6%),两组差异有统计学意义(P<0.05),B组发生率显著低于A组。[结论]颈椎后路减压术后C5神经根麻痹有一定的发生率,椎板切除减压内固定术发生率相对较高,但两种方法并无统计学差异;加行C4、5椎间孔减压术可降低颈椎后路减压术后C5神经根麻痹的发生率。更多还原

【Abstract】 [Objective] This study aimed to evaluate the incidence of C5 palsy after posterior cervical decompression surgery and the possible reasons,and to discuss the effect of bilateral foraminotomy on preventing C5 palsy. [Methods] The clinical data of 131 patients( 86 males and 45 females,with the mean age of 58. 3 ± 10. 9 years) received posterior cervical decompression between June 2005 and May 2012 were retrospectively studied. Among these patients,63 received posterior laminoplasty and 68 underwent laminectomy,and in addition,67 cases underwent posterior cervical decompression surgery( Group A) and other 64 cases received posterior cervical decompression surgery with bilateral foraminotomy at C4、5level( Group B). The pre-and post-operative clinical date,pre-operative radiographic parameters and the incidence of C5 palsy were studied. [Results] All patients were followed up for 12 ~ 54 months,averaged( 23. 4 ± 8. 8) months. Postoperative C5 nerve root palsy occurred in 9 cases,and the overall incidence was 6. 9%,including 3 cases in laminoplasty group( 4. 8%) and six cases in laminectomy group( 8. 8%). There was significant difference in incidence of C5 palsy between group A and group B( 11. 9%vs. 1. 6%,P < 0. 05). [Conclusion] There was a certain incidence of C5 palsy after posterior cervical decompression surgery,the incidence of C5 palsy after laminectomy is relatively higher than that after laminoplasty,but there is no statistically significant difference between the two surgical procedures. Bilateral foraminotomy at C4、5level is effective for preventing C5 palsy after posterior cervical decompression surgery.更多还原