颈椎后路椎间孔开大预防颈5神经根麻痹临床疗效分析

目的：评估颈椎后路椎间孔开大对降低颈椎后路术后颈5神经根麻痹发生率分析。方法：2005年1月至2011年4月共有46例颈椎病患者接受了颈椎后路减压结合椎弓根钉内固定手术治疗,男性31例,女性15例。25例（A组）接受单纯椎板切除减压内固定,21例（B组）同时行椎间孔开大术。对两组患者的临床资料、影像学资料以及颈5神经根麻痹发生率进行分析。结果：A组有2例患者（8%）发生了C5神经根麻痹症状,B组没有发生C5神经根麻痹症状（P〈0.05）。2例患者均诊断为连续型后纵韧带骨化症,在随访中（24个月）,均完全缓解。结论：新手术方法在一定程度上对预防C5神经麻痹起到积极的作用,因此推荐在行颈椎后路减压手术时对颈4-5椎间孔开大预防C5神经麻痹。

Clinical Analysis of Preventing C5 Palsy with Foraminotomy

Objective： To evaluate the effects of C4 -5 partial foraminotomy on reducing the occurrence of C5 palsy after cervical decompression surgery. Methods： A total of 46 patients （male 31, female 15 ）who underwent the cervical decompression surgery with pedicle screw insertion between Jan. 2005 and Dec. 2011 were recruited. Twenty five cases （Group A） underwent the posterior lamineetomy with pedicle screw insertion, while 21 cases （Group B） received posterior laminectomy with pedicle screw insertion, combined with partial C4 -5 foraminotomy at C4 -5 level. The clinical data, radiographic parameters and the occurrence of C5 palsy of all cases were assessed. Results ： Postoperative C5 palsy occurred in 2 cases （8%） in group A and none in group B. The difference in the incidence of C5 palsy was significant between two groups. Both cases were diagnosed as continuous OPLL, and had good prognosis for neurological and functional recovery during the 24 - month follow - up. Conclu- sion： The new operation procedure is effective for preventing C5 palsy in certain circumstances. And the posterior laminectomy with pedicle screw insertion, combined with partial C4 -5 foraminotomy at C4 -5 level is necessary for patients with cervical dis- order.