正常人颈段脊柱结构内nNOS阳性神经末梢的分布

目的 探讨颈肩痛的发病机制。方法 用免疫组化ABC法观察人颈段脊柱结构内神经元型一氧化氮合酶（nNOS）免疫反应阳性神经末梢情况。结果 人颈椎关节突关节囊的纤维层、黄韧带、棘间韧带、棘上韧带和椎间盘的纤维环内均有nNOS免疫反应阳性神经末梢的存在，这些神经末梢呈树枝状或念珠状，其走行与结缔组织层平行。结论 一氧化氮（NO）参与人颈椎关节突关节囊、黄韧带、棘间韧带、棘上韧带和椎间盘的纤维环等结构的伤害性感觉信息的传递。人颈段脊柱相关结构的神经末梢受刺激时，促使NO的释放和传递可能是引起原发性颈肩痛的原因之一。     

背根神经节内P物质、降钙素基因相关肽免疫阳性神经元与阴茎包皮系带感觉信息的传递

目的：探讨背根神经节（DRG）内P物质（SP）、降钙素基因相关肽（CGRP）免疫阳性神经元与阴茎包皮系带感觉信息传递之问的关系。方法：通过荧光金（FG）逆行标记对大鼠阴茎包皮系带内神经末梢的来源作追踪定位，并结合SP、CGRP免疫荧光标记法，研究大鼠DRG内FG标记阳性神经元中SP、CGRP免疫阳性神经元的形态和分布。结果：FG逆行标记结果发现，大鼠阴茎包皮系带内的神经末梢起源于第6腰髓对应的背根神经节（L6-DRG）和第1骶髓对应的背根神经节（S1-DRG）的神经元。对这些神经元分别作SP、CGRP免疫荧光标记后发现，标记细胞大小不等，分别呈深红色和深绿色，沿神经束成行排列或散在分布。FG／SP、FG／CGRP双标记阳性细胞均为中小型，其数量分别占FG逆行标记阳性细胞总数的1／3和1／2，FG／SP／CGRP三标记阳性细胞占FG逆行标记阳性细胞总数的1／5。结论：大鼠L6-DRG和S1-DRG内的SP、CGRP免疫阳性神经元可能参与阴茎包皮系带感觉信息的传递。     

背根神经节内P物质、降钙素基因相关肽免疫阳性神经元与阴茎包皮系带感觉信息的传递

目的:探讨背根神经节(DRG)内P物质(SP)、降钙素基因相关肽(CGRP)免疫阳性神经元与阴茎包皮系带感觉信息传递之间的关系。方法:通过荧光金(FG)逆行标记对大鼠阴茎包皮系带内神经末梢的来源作追踪定位,并结合SP、CGRP免疫荧光标记法,研究大鼠DRG内FG标记阳性神经元中SP、CGRP免疫阳性神经元的形态和分布。结果:FG逆行标记结果发现,大鼠阴茎包皮系带内的神经末梢起源于第6腰髓对应的背根神经节(L6-DRG)和第1骶髓对应的背根神经节(S1-DRG)的神经元。对这些神经元分别作SP、CGRP免疫荧光标记后发现,标记细胞大小不等,分别呈深红色和深绿色,沿神经束成行排列或散在分布。FG/SP、FG/CGRP双标记阳性细胞均为中小型,其数量分别占FG逆行标记阳性细胞总数的1/3和1/2,FG/SP/CGRP三标记阳性细胞占FG逆行标记阳性细胞总数的1/5。结论:大鼠L6-DRG和S1-DRG内的SP、CGRP免疫阳性神经元可能参与阴茎包皮系带感觉信息的传递。     

腰椎相关结构的SP能神经支配

腰痛是临床经常遇见的问题，近几年来对脊柱结构内神经末梢的化学性质的研究报道较多犤１－６犦。P物质（SP）能够介导疼痛的发生，但是，有关人腰椎关节突关节囊、黄韧带、棘间韧带、棘上韧带和椎间盘的纤维环上是否存在SP阳性的神经末梢，还未见文献报道。因此研究脊柱结构内SP神经纤维的存在，对理解腰痛的发生是有必要的。资料和方法本组根据Douglas犤４犦介绍的人体材料取材和处理方法，手术切取３例因急性脑损伤意外死亡者（２小时内）的腰椎关节突关节囊、黄韧带、棘间韧带、棘上韧带和椎间盘的纤维环部分材料。然后应用免疫组化…     

阴茎包皮及包皮系带内SP免疫阳性神经末梢的分布和来源

目的观察成人阴茎包皮和包皮系带内P物质(substanceP,SP)免疫阳性神经末梢的分布和来源。方法免疫组织化学法观察SP免疫阳性神经末梢的分布,荧光金(fluoro-gold,FG)逆行追踪和SP免疫荧光标记相结合法研究大鼠包皮系带内SP免疫阳性神经末梢的来源。结果成人阴茎包皮及包皮系带内均有密集的SP免疫阳性神经末梢存在,这些神经末梢主要位于表皮基底层,呈树枝状或念珠状分布,大多成束走行。阴茎系带处SP免疫阳性神经末梢的分布密度明显大于阴茎包皮处。FG逆标阳性细胞位于大鼠第六腰髓对应的背根神经节(L6-DRG)和第一骶髓对应的背根神经节(S1-DRG)。阳性细胞大中小不等,大多沿神经束成行排列或散在分布。SP免疫荧光标记细胞大多为中小型,呈深红色。FG/SP双标阳性细胞均为中小型,其数量占FG逆标阳性细胞总数的三分之一。结论SP参与了阴茎包皮及包皮系带感觉信息的传递。大鼠阴茎包皮系带内SP免疫阳性神经末梢源自于L6-DRG和S1-DRG。     

SP和CGRP在大鼠牙髓组织中的分布及意义

目的：研究大鼠牙髓组织中神经肽SP和CGRP免疫阳性神经纤维的分布及意义。方法：利用免疫组织化学方法对大鼠牙髓组织切片进行染色，在显微镜下观察SP和CGRP免疫阳性神经纤维的分布。结果：SP阳性神经纤维分布在牙髓组织，并主要伴随在血管周围，CGRP阳性神经纤维与SP阳性神经纤维分布类似，但数量较多。结论：CGRP与SP在牙髓组织中分布类似，可能包含在同一种神经纤维中，二者协同作用，调节牙髓血管的血流分布。     

颈椎病上臂痛与小圆肌压痛点关系的研究

目的研究小圆肌无菌性炎症模型脊髓背根节（DRG）的电生理特征及该背根节内和上臂皮下组织神经递质P物质（SP）含量的变化，以解释小切口软组织松解术治疗颈肩痛及神经根型颈椎病的机理。方法用电生理方法检测福尔马林造成的大鼠小圆肌无菌性炎症模型及生理盐水对照模型的急性期（造模后即刻）和慢性期（造模后15天）颈5背根节自发放电频率；用放射免疫方法（RIA）分别检测急性期（造模后24h）和慢性期（造模后15天）实验组和对照组颈5背根节及上臂皮下组织SP含量。结果实验组大鼠颈5背根节各时段自发放电频率均较对照组显著增加（P〈0．05）；实验组动物在急性期和慢性期颈5背根节内及上臂皮下组织SP含量均较对照组显著增高（P〈0．05）。结论小圆肌处无菌性炎症可以导致脊髓背根节自发放电频率增加，兴奋性提高，由此引起背根节内及上臂皮下组织致痛递质SP增加，结果导致根性疼痛及上肢放散。小圆肌松解术不仅可以治疗因局部无菌性炎症导致的颈肩痛，而且为神经根型颈椎病的治疗开辟了一条新的途径。     

颈前路椎间过度撑开与术后颈肩痛关系的探讨

目的：探讨颈前路椎间过度撑开与术后颈肩痛的相关性。方法：65例因脊髓型颈椎病行颈前路减压植骨固定手术的患者．根据手术节段分为单节段、双节段和三节段组，统计每组术后出现和未出现颈肩痛患者的椎体间高度和成角变化、颈部VAS疼痛评分和NDI（颈椎功能指数）评分情况，分析出现颈肩痛与颈部长度和术中是否切开后纵韧带的相关性，同时观察术后颈肩痛的性质、部位、诱发因素、持续时间、缓解时间和方法。结果：在各组中，术后出现和未出现颈肩痛患者颈部VAS疼痛评分和NDI评分具有显著性差异（P〈0．05）。单节段手术患者椎间成角变化，双节段和三节段手术患者椎间高度变化在有症状和无症状组存在显著性差异（P〈0．05）．颈部长度以及术中是否切开后纵韧带与术后颈肩痛的发生无显著相关性。术后颈肩痛多为无明显诱因局部不适疲劳感，多位于颈中线两侧，出现时间多为术后6h内，每次持续时间约为30min，服用非甾体类消炎止痛药在术后约1．8个月缓解。结论：颈前路术中椎间过度撑开致术后椎间隙高度增加过多或椎间成角过大与术后颈肩部疼痛相关。     

大鼠皮肤降钙素基因相关肽正常分布及烫伤后改变规律

目的探讨皮肤创面降钙素基因相关肽(CGRP)的来源。方法运用免疫组化技术检测烫伤后早期大鼠皮肤烫伤创面,创周及远处未损伤皮肤内含 CGRP 的神经分布密度改变。结果烫伤后15 min 在以上所有部位的含 CGRP 神经纤维分布密度明显下降。烫伤后6至12 h 达到最低值,而后逐渐恢复,相比之下,在创周恢复过程出现较早;此外,在创面和创周的真皮层 CGRP免疫反应阳性的巨噬细胞样大细胞从局部血管中游出,烫伤后12 h 该细胞与含 CGRP 神经关系密切,烫伤后24 h 该细胞染色增强,破碎并释放大量 CGRP 免疫反应阳性的颗粒状物质,而后这些细胞在局部消失。结论在皮肤创面针对烧伤损害 CGRP 可能不仅从皮肤神经末端释放,也能由局部炎性细胞合成释放。     

自体髓核移植后大鼠腰髓背角痛觉相关物质的变化

目的 :探讨腰椎间盘突出症相关腰腿痛发病的可能机制。方法 :在大鼠的硬膜外腔移植自体髓核 ,然后通过免疫组化的方法测定大鼠L4～ 6脊髓后角中CGRP和SP的变化。结果 :在硬膜外腔移植自体髓核后 ,L4～ 6节段脊髓背角浅层中CGRP和SP阳性神经纤维终末的面积也明显增加 ,统计学分析证实与对照组相比较有显著性差别 (P <0 .0 5 )。结论 :髓核本身的自身免疫和 /或生物化学炎症反应在腰椎间盘突出症相关的腰腿痛中起到重要的作用     

Management of chronic pain in whiplash injury

We investigated the response of chronic neck and shoulder pain to decompression of the carpal tunnel in 38 patients with whiplash injury. We also determined the plasma levels of substance P (SP) and calcitonin gene-related peptide (CGRP), which are inflammatory peptides that sensitise nociceptors. Compared with normal control subjects, the mean concentrations of SP (220 v 28 ng/l; p < 0.0001) and CGRP (400 v 85 ng/l; p < 0.0005) were high in patients with chronic shoulder and neck pain before surgery. After operation their levels fell to normal. There was resolution of neurological symptoms with improvement of pain in 90% of patients. Only two of the 30 with chronic neck and shoulder pain who had been treated conservatively showed improvement when followed up at two years. In spite of having neuropathic pain arising from the median nerve, all these patients had normal electromyographic and nerve-conduction studies. Chronic pain in whiplash injury may be caused by 'atypical' carpal tunnel syndrome and responds favourably to surgery which is indicated in patients with neck, shoulder and arm pain but not in those with mild symptoms in the hand. Previously, the presence of persistent neurological symptoms has been accepted as a sign of a poor outcome after a whiplash injury, but our study suggests that it may be possible to treat chronic pain by carpal tunnel decompression.     

腰椎间盘源性疼痛机理的临床研究

目的 :分析腰椎间盘突出症病人的临床症状、体征与椎间盘和神经根大体病理形态改变的关系 ,临床症状、体征和椎间盘突出类型与髓核中炎症介质 (磷脂酶A2 )水平的关系以及临床症状、体征和椎间盘突出类型与脑脊液 (以下简称CSF)中神经肽类递质变化的关系。从临床角度探讨腰椎间盘突出症疼痛机理。材料与方法 :分析161例腰椎间盘突出病人的髓核突出类型及神经根病理形态改变与腰腿痛程度的关系 ;分析 2 0例腰椎间盘髓核组织中磷脂酶A2 活性水平与神经根性疼痛程度的关系 ;3 1例腰椎间盘突出症病人脑脊液中P物质和降钙素基因相关肽含量与神经根性疼痛程度进行比较。结果 :①腰椎间盘的膨出、突出、脱出和脱出游离各组之间无疼痛程度的统计学显著差异。而神经根呈急性炎症反应的病人中重度疼痛高达 80 % (P <0 .0 1)。②腰椎间盘突出症病人椎间盘髓核中磷脂酶A2 活性显著高于自身血液中和健康人椎间盘髓核中磷脂酶A2 活性水平 ,腰椎间盘突出症病人的腰腿痛程度与其髓核中磷脂酶A2 活性明显相关。③腰痛病人脑脊液中P物质和降钙素基因相关肽水平高于正常对照组 ,并与疼痛等级有关。结论 :①腰椎间盘突出物的病理形态和对神经根的机械压迫与其引起的临床疼痛症状和神经根体征无明确关系 ,而神经根性疼痛与局部     

人神经生长因子β基因转染对神经病理性痛大鼠脊髓背角致痛物质含量的影响

目的 探讨人神经生长因子β(hNGFβ)基因转染对神经病理性痛大鼠脊髓背角降钙素基因相关肽(CGRP)和P物质(SP)含量的影响.方法 雄性SD大鼠48只,体重200～250 g,随机分为3组(n=16):假手术组(Ⅰ组)假手术后立即鞘内注射人工脑脊液;Ⅱ组和Ⅲ组制备坐骨神经慢性压迫性损伤(CCI)模型,术后分别立即鞘内注射人工脑脊液或重组腺病毒介导入神经生长因子β(Ad-hNGFβ)基因.于术前1 d、转染后28 d内每4天测定热痛阈、机械痛阈及行为学评分.每组分别于转染后4、7、14及28 d各处死4只大鼠,取脊髓组织,采用免疫组织化学法测定SP和CGRP含量.结果 与Ⅰ组比较,Ⅱ组和Ⅲ组行为学评分升高,机械痛阈及热痛阈均降低(P<0.01);与Ⅱ组比较,Ⅲ组行为学评分及机械痛阈差异无统计学意义(P>0.05),转染后8～24 d热痛阈升高(P<0.05).术后Ⅱ组和Ⅲ组术侧脊髓背角SP及CGRP含量明显高于Ⅰ组,术后7～28 dm组术侧脊髓背角SP及CGRP含量明显低于Ⅱ组(P<0.05或0.01).结论 Ad-hNGFβ基因转染可能通过降低脊髓背角SP及CGRP含量减轻神经病理性痛大鼠的热痛觉过敏.     

颈髓神经根硬膜性被膜内神经末梢分布的研究

目的 调查人颈髓神经根硬膜性被膜内神经末梢的数量分布,探讨颈神经根性疼痛的发病机制。 方法 对１８例病理解剖尸体３９个颈神经根、神经节及其远端的脊髓神经标本,采用铃木镀银染色法及Ｋｌｕｖｅｒ－Ｂａｒｒｅｒａ髓鞘染色法,制得２０μｍ连续切片２０６９张,用光学显微镜定量地观测了上述部位神经组织被膜中各种神经感受器的形态结构及其存在的部位、数量和分布的特点。 结果 神经根、神经节及脊髓神经被膜内存在游离     

MRI changes of cervical spine in asymptomatic and symptomatic young adults

Several work-related, psychosocial and individual factors have been verified as being related to neck and shoulder pain, but the role of pathology visualized by magnetic resonance imaging (MRI) remains unclear. In this study, the relationship between neck and shoulder pain and cervical high-field MRI findings was investigated in a sample of persons in a longitudinal survey. The study aimed to determine whether subjects with persistent or recurrent neck and shoulder pain were more likely to have abnormal MRI findings of cervical spine than those without neck and shoulder pain. A random sample of 826 high-school students was investigated initially when the students were 17-19 years, and again when they had reached 24-26 years of age. Eighty-seven percent participated in the first survey in 1989, of whom 76% took part in the second survey, in 1996. The validated Nordic Musculoskeletal Questionnaire was used to collect data about neck and shoulder symptoms. Two groups were chosen for the MRI study: the first group ( n=15) consisted of the participants who had reported no neck and shoulder symptoms in either of the inquiries, while the second group ( n=16) comprised those who were suffering from neck and shoulder symptoms once a week or more often at the time of both surveys. The degrees of disc degeneration, anular tear, disc herniation and protrusion were assessed by two radiologists. The differences between the two study groups were evaluated. The study found that abnormal MRI findings were common in both study groups. Disc herniation was the only MRI finding that was significantly associated with neck pain. These findings indicate that pathophysiological changes of cervical spine verified on MRI seem to explain only part of the occurrence of neck and shoulder pain in young adults.     

扩大后壁减压术治疗颈椎后纵韧带骨化

目的 介绍扩大后壁减压术(显露根袖起始部)治疗颈椎后纵韧带骨化(ossification of the posterior longitudinal ligament,OPLL)合并脊髓病,并探讨其疗效.方法 1998年1月至2005年12月,采用扩大后壁减压手术治疗颈椎OPLL患者82例.男47例,女35例;年龄39～84岁,平均57岁.节段型31例,连续型40例,混合型11例.手术前后用日本矫形外科学会(JOA)评分判定神经功能;用疼痛视觉模拟评分(VAS)评价颈肩痛程度;用Ishihara法测定颈椎曲率指数(cervical curvature index,CCI);在MRI上测量脊髓扩大和后移程度.结果 手术平均减压5.2(4～6)个节段.全部病例随访13～58个月,平均41个月.术后JOA评分平均为13.9(11～17)分,较术前[10.9(7～15)分]有显著改善(t=14.65,P＜0.01),临床效果优良率为98.7%.仅2例出现C5神经根麻痹,为一过性.术后颈肩痛VAS评分平均为1.4(1～3)分,较术前[5.3(4～6)分]明显缓解(t=15.46,P＜0.01).术后CCI平均为10.5%,较术前(18.8%)下降(t=5.03,P＜0.01),但未发生颈脊髓再次受压.MRI测量:最狭窄处硬膜囊平均横截面积由85.4 mm2增至153.8 mm2,较术前增加80.1%(t=16.33,P＜0.01);颈脊髓较术前所在位置平均向后移动6.2mm(t=15.35,P＜0.01).结论 显露根袖起始部的扩大后壁减压术能使脊髓充分后移,减压彻底,降低脊髓轴位张力,避免C5神经根麻痹,术后无颈椎脱位或半脱位,未出现颈脊髓受压复发情况.

Abstract：

Objective To introduce the surgical strategy of enlarged laminectomy (with partial facet joint dissection to expose the nerve root), and to discuss its benefit for cervical ossification of the posterior longitudinal ligament(OPLL) with myelopathy. Methods Totally 82 patients with cervical OPLL were treated by enlarged laminectomy from January 1998 to December 2005. There were 47 males and 35 females, with an average age of 57 years (ranged, 39-84 years). Among them, there were 31 cases of the solitary type, 40 cases of the continuous type, and 11 cases of the mixed type. JOA scoring system and the visual analogue scale (VAS) scoring were applied to evaluate the neurological function and neck/shoulder pain respectively.Ishihara method was employed to measure cervical curvature index(CCI). The degree of spinal cord backward expanding and displacement were calculated in MR1. Results The mean decompression length was 5.2 (4-6) segments. The mean follow-up duration was 41 months (ranged, 13-58 months). JOA score has improved from 10.9(7-15) preoperatively to 13.9(11-17) postoperatively (t=14.65, P＜0.01). The excellent and good rate was 98.7%. The palsy of C5 nerve root occurred in only 2 patients, both recovered after surgery. Zhe mean postoperative VAS score was 1.4(1-3), comparing with the preoperative score of 5.3 (4-6). The pain in neck/shoulder was alleviated obviously (t=15.46, P＜0.01 ). CCI decreased from 18.8% to 10.5%(t=5.03, P＜0.01 ),but did not follow by neuron function deterioration. MRI indicated that the cross-sectional area at the level of maximum compression of the dural sac increased from 85.4 mm2 preoperatively to 153.8 mm2 postoperatively (t=16.33, P＜0.01), and the mean spinal cord posterior shift was 6.2 mm (t=15.35, P＜0.01). Conclusion The enlarged laminectomy is proved to be effective in treating cervical OPLL, in terms of significant posterior shift of the spinal cord, relief of cervical/shoulder pain, lower rate of the palsy of C5 nerve root, with no recurrence of spinal cord compression symptom.     

Immunohistochemical study on the effect of high tibial osteotomy on the distribution pattern of neuropeptides in the synovium of the osteoarthritic knee]

Synovial tissue was obtained from 18 knees with medial compartmental osteoarthritis (OA) and from 20 knees on which a high tibial osteotomy had been performed. Neuropeptides were stained with a specific avidin-biotin-peroxidase method. Comparisons were made of the incidence of staining as well as the location of staining within the synovia (medial, lateral, and suprapatellar regions). The results showed that the synovium had an extensive neural network of both the somatic and autonomic nervous systems. In the medial synovium of the preoperative knees, the neuropeptides were found in abundance. An especially strong response for substance P (SP) and calcitonin gene-related peptide (CGRP) was observed at the free nerve endings. However, the postoperative incidence of SP-positive free nerve endings was reduced to 54% of the preoperative amount and the inflammation subsided in the medial region. These findings suggested that free nerve endings containing SP might be mainly involved in the inflammation and pain of OA.     

Shoulder pain and function after neck dissection with or without preservation of the spinal accessory nerve

To compare the difference in the degree of pain and functional disability of the shoulder in patients who underwent neck dissection for the treatment of head and neck cancer, 23 patients with and 12 patients without spinal accessory nerve preservation were evaluated with a questionnaire and a physical examination. In addition, to determine what effect radiation treatment has on pain and shoulder disability, eight patients who had whole neck radiation but no neck dissection were similarly evaluated. The results of this study show that, on the average, neck dissection patients with their spinal accessory nerve preserved have less pain in their shoulders, less functional disability, and stronger results on their physical examination than did those with their spinal accessory nerve sacrificed. It was also found that the patients who received whole neck radiation treatment without neck dissection had little pain, infrequent and insignificant functional disability, and normal strength on physical examination.     

The symptomatic incompetent cervical intervertebral disc

A series of 16 patients with symptoms such as pain in the neck, occiput, shoulder and arm; numbness in the hands; and/or difficulty in walking, is described. Neurological examination of the upper extremities disclosed signs of nerve roots dysfunction in 5 patients and long tract signs in 12, whereas examination of the lower extremities disclosed long tract signs in every patient. Positive contrast cervical myelograms suggested mild posterior bulging of one or two intervertebral discs in every patient, but computed tomographic myelograms invariably demonstrated a coincident narrow cervical spinal canal, thus revealing the true compressive potential of the aforementioned mild disc protrusion on the spinal cord. All patients underwent anterior cervical microdiscectomy of the offending disc or discs, which were found to be degenerated. No case of frank rupture of the anulus was identified. Response to treatment was graded as excellent in 12 patients, who had complete relief of symptoms, and good in 4 patients, who had mild residual complaints. This study suggests that incompetence (bulging) of a cervical intervertebral disc may acquire important clinical significance in the presence of a narrow spinal canal by compressing the spinal cord and the corresponding nerve roots. Surgical removal of the diseased disc may result in restoration of neurological function.     

单开门椎管扩大成形术后颈椎曲度与C_5神经根麻痹的关系

目的探讨单开门椎管扩大成形术后颈椎曲度与C5神经根麻痹发生率的关系。方法对254例颈椎病患者采取3种不同术式治疗:A组(126例)行颈椎单开门椎管成形术;B组(70例)行颈椎单开门椎管成形+未明显改变颈椎曲度的后路内固定术;C组(58例)行颈椎单开门椎管成形+明显改变颈椎曲度的后路内固定术。结果患者均获得随访,时间12~18个月。X线、MRI和CT检查显示:3组患者脊髓均有不同程度的向后漂移,侧块螺钉均没有进入椎间孔和椎管内,椎板没有再关门,椎板合页处没有向内陷入椎管,亦没有明显压迫硬膜脊髓的硬膜外血肿。A组颈椎曲度无改变;B组颈椎曲度无显著性改变;C组颈椎曲度改善明显,曲度增加值为5.3 mm±2.7 mm。18例术后发生C_5神经根麻痹,其中A组2例(1.59%)、B组4例(5.71%)、C组12例(20.69%);A、B两组比较差异无统计学意义(P0.05),A、B组与C组比较差异均有统计学意义(P0.017);脊髓型组5例(3.09%),混合型组13例(14.13%),两组比较差异有统计学意义(P0.05)。18例C_5神经根麻痹患者于术后2~4 d出现颈肩痛或原有颈肩痛加重,其中12例随后迅速出现肌力下降,而感觉减退不明显。18例均给予保守治疗,术后2~3周患者颈肩部麻痛消失;术后4~24周12例肌力下降中11例完全康复,1年后另1例C_5神经支配区肌力恢复至4+级。结论颈椎单开门椎管扩大成形术后可发生C_5神经根麻痹,无内固定时发生率最低,在颈椎生理曲度明显改变时发生率最高;术后混合型较脊髓型更易出现C_5神经根麻痹,其损伤机制可能与脊髓漂移有关。