椎间孔切开在预防椎板成形术后并发C5神经根麻痹中的作用

 目的 探讨椎间孔切开在预防C_4，5颈椎后纵韧带骨化后路单开门椎板成形术并发C₅神经根麻痹中的作用。方法 2008年1月至2012年10月应用锚定法单开门椎板成形术治疗后纵韧带骨化患者155例，男75例，女80例；年龄38~75岁，平均54.5岁。单纯单开门椎板成形术（开门组）90例，单开门椎板成形术同时行C_4，5椎间孔切开（切开组）65例。术后8周、1年评估日本骨科协会（Japanese Orthopaedic Association，JOA）评分及改善率，C₅神经根麻痹发生率，C₅神经根麻痹患者神经功能及预后状况；影像学上颈椎曲度指数、开门角度变化、脊髓前缘及后缘向后漂移距离。结果 手术时间90~140 min，平均（110±14） min；术中出血量100~250 ml，平均（160±45） ml。随访时间12~18个月，平均15.4个月。两组术后8周、1年JOA评分及改善率的差异均无统计学意义。开门组术后C5神经根麻痹发生率8.89%（8/90），切开组4.62%（3/65），两组差异有统计学意义。C₅神经根麻痹均表现在开门侧。两组颈椎曲度指数术前、术后8周、术后1年及组间比较差异均无统计学意义；术后1年椎板开门角度与术后8周比较差异无统计学意义；脊髓前缘后移距离术后不同时点及组间差异均无统计学意义；术后1年脊髓后缘后移距离与术后8周比较差异无统计学意义。结论 应用单开门椎板成形术治疗颈椎后纵韧带骨化同时行C_4，5椎间孔切开可降低术后C₅神经根麻痹的发生率，对术后JOA评分改善率没有明显影响。

Effect of partial foraminotomy after laminoplasty surgery on preventing C5 nerve root palsy

Objective To investigate clinical curative effect of partial foraminotomy after C_4，5 ossification of posterior longitudinal ligament (OPLL) on preventing C₅ nerve root palsy. Methods A total of 155 patients with OPLL were treated with expansion open-door laminoplasty (EOLP) between January 2008 and October 2012, including 75 male patients and 80 female patients, with average age of 54.5 (ranging from 38 to 75). Among them, 90 cases took EOLP (open team), and 65 cases took EOLP and C_4，5 partial foraminotomy (incision team). Clinical curative effect and imaging evaluation were used in 8 weeks and 12 months after operation. JOA scores, JOA scores improvement rate, C₅ nerve root palsy occurrence rate, neurological function of patients with C5 nerve root palsy and the prognosis, cervical curvature index, opening angular variation, backward drift distance of anterior margin and posterior margin of the spinal cord were evaluated after 8 weeks and 1 year after the surgery. Results The operation time was 90-140 min, with the average time of 110±14 min; mean bleeding volume was 160±45 ml (ranging from 100 to 250 ml); follow-up visit time was 15.4 months on average (ranging from 12 to 18 months). JOA score and improvement rate after 8 weeks and 1 year of the operation have no statistical significance. The C₅ nerve root palsy occurrence rate in open team was 8.89% (8/90), while that in incision team was 4.62% (3/65). The difference of two groups has statistical significance. C₅ nerve root palsy all happened in laminar opening side. Comparison of cervical curvature index of two groups before the operation and after 8 weeks of the operation and inter-group comparison have no statistical significance. The difference between laminar opening angle after 1 year of the operation and laminar opening angle after 8 weeks has no statistical significance. The difference of backward drift distance of anterior margin of the spinal cord at different time after the operation and inter-group difference have no statistical significance. The difference in backward drift distance of posterior margin of the spinal cord between 1 year after the operation and 8 weeks after the operation has no statistical significance. Conclusion Treating OPLL with EOLP and C_4，5 partial foraminotomy can reduce occurrence rate of C₅ nerve root palsy, but has no significant influence on JOA score improvement rate.