颈椎前路椎间隙减压融合固定致 C5神经根麻痹的影响因素分析

来源 :临床骨科杂志 | 被引量 : 0次 | 上传用户:yesterday23
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目的:探讨颈椎前路椎间隙减压融合固定致上肢外展上举受限的相关因素。方法对255例颈椎病患者行颈椎椎间隙减压融合内固定术,根据术后患者是否出现上肢外展上举受限,将患者分为受限组(15例)和未受限组(240例)。采用JOA评分法评估患者术前、术后神经功能;采用颈椎功能障碍指数( NDI)评价颈椎疗效。分析影响上肢外展上举受限的影响因素。结果255例患者均获得随访,时间7~12个月。15例术后上肢外展上举受限者颈椎JOA评分由术前(8.8±1.7)分提高至(13.8±2.3)分;颈椎NDI评分由术前平均(9.7±2.2)分下降至末次随访时的(2.5±1.5)分。术后C4~5椎间盘退变评分、C4~5节段椎间隙高度增加量受限组与未受限组比较差异无统计学意义( P >0.05);受限组中,术前 C3~5脊髓信号改变比率为8/15(53.3%),明显高于未受限组的3/240(1%),差异有统计学意义(P<0.01)。受限组者中,手术节段≤2个者上肢受限发生率(3/15)显著低于手术节段3个者(12/15)。结论颈椎前路椎间隙减压融合固定后上肢外展上举受限的患者预后较好,患者多节段减压手术及术前C3~5脊髓高信号为术后发生上肢外展上举受限的影响因素。“,”Objective To investigate the associated factors of C 5 root palsy after anterior cervical decompression and fusion.Methods 255 patients with cervical spondylosis underwent anterior cervical decompression and fusion .They were divided into two groups aoccording to wether they appeared the upper extremity abduction and lift limitation or not after operation:limited group(n=15) and no limited group(n=240).Japanese Orthopaedic Association (JOA) score and neck disability index ( NDI) score were taken to evaluate the spinal cord function before operation and at fi-nal follow up.And the influencing factors of the upper extremity abduction and lift limitation were analyzed .Results 255 cases of patients were followed up for 7~12 months after operation ,15 patients appeared the upper extremity ab-duction and lift limitations .The score of JOA after operation were higher than that of preoperation significantly (13.8 ±2.3 vs 8.8 ±1.7) (P<0.01),score of NDI after operation were lower than that of preoperation (9.7 ±2.2 vs 2.5 ±1.5) (P0.05).The C3~5 signals change rate in MRI with upper function limitation were higher than that in other group [8/15 (53.3%) vs 3/240(1%)] (P<0.01).Limitation rate of patients who received less than 2 levels decompression were lower than that of patients with more than 3 levels decompression (3/15 vs 12/15) (P<0.01).Conclusions Patients with the upper extremity abduction and lift limitation anterior cervical decompression and fusion has a good prognosis after active treatment .Multiple segment decompression and C 3~5 area high signal on T 2-MRI images preop-eratively may be associated with upper extremity abduction and lift limitation after anterior cervical decompression and fusion.
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