颈椎单开门椎管成形术后C5神经麻痹的致病因素分析

目的:探讨颈椎单开门颈椎管成形术不同危险因素与术后C5神经麻痹发生的关系。 方法: 回顾性分析2009年1月-2012年12月，行颈椎单开门颈椎管成形术治疗脊髓型颈椎病患者254例。 按术后是否发生C5神经麻痹分为：麻痹组，20例；无麻痹组，234例进行分析。比较两组间的危险因素与C5神经麻痹发生的关系，分析可能影响C5神经麻痹发生的致病因素。结果：全部病例获得随访，平均（24.9±2.6）月，对比两组患者在术后改变的危险因素中，术后CCI（t=10.015 P＜0.05），开门角度（t=5.125 P＜0.05），脊髓后移（t=10.159 P＜0.05），方面的差异具有统计学意义。脊髓内缺血信号、后纵韧带骨化、椎间孔狭窄方面的差异无统计学意义。进行多因素Logistic回归，C5神经麻痹危险因素Logistic回归多因素分析结果显示，脊髓后移，开门角度，颈椎术后CCI与C5神经麻痹之间存在统计学关联，OR（95%CI）值分别为3.542（2.465~9.254）、2.035（1.684~2.359）、9.126（4.425~17.273）。结论：在术中开门角度过大；术后CCI较大以及术后脊髓后移较大是引起颈椎单开门管成形术后发生C5神经麻痹的危险因素。

Analysis of C5 palsy after open door laminoplasty

Objective: To discuss the relationship of C5 never palsy incidence and difference risk factor after cervical open door laminoplasty. Methods： This study involved the patients with cervical spondylotic myelopathy who nuderwent expansive open door laminoplasty between January 2009 and December 2012. All the patients were average follow up (24.9 + 2.6) months. They were classified into two groups according to whether occur C5 palsy，group A ,20 cases occur C5 palsy and group B，234 cases without. Compare two groups of different risk factors and postoperative C5 palsy occurred, analyze the factors may affect the C5 palsy occurred. Results: All cases received follow-up (24.9 + 2.6) months on average, compared two groups of patients in postoperative changes of risk factors for postoperative CCI（t=10.015 P＜0.05）, lamina open angles (（t=5.125 P＜0.05）), spinal cord shift (t=10.159 P＜0.05), the difference is statistically significant. Preoperative intramedullary high signal 、OPLL（Ossification Of Posterior Longitudinal Ligament）、Intervertebral foramen stenosis differences without statistical significance. C5 palsy risk factors, according to the results of Logistic regression analysis of multiple factors in the Spinal cord shift, lamina open angles, postoperative CCI and statistical correlation between C5 palsy, OR（95%CI）:3.542（2.465~9.254）、2.035（1.684~2.359）、9.126（4.425~17.273）. Conclusion: The Angle of open door too large; CCI and spinal cord shift is risk factors for postoperative C5 palsy.