各种多节段颈椎减压术后颈5神经根麻痹发生率的比较

目的研究采用不同的颈椎手术方式进行颈椎减压术后颈5神经根麻痹的发生率。方法回顾分析375名仅进行相连多节
段颈椎减压手术的患者。研究对象为进行颈椎多节段减压的患者。手术方式包括前路椎体次全切除植骨融合内固定术、颈椎
前路椎体次全切除植骨融合内固定术+后路减压植骨融合内固定术、颈椎后路椎板切除减压、植骨融合内固定术及后路椎板成
形植骨融合术。对于没有定期随访、由于脊髓损伤造成术前及术后无法查体对比、手术范围不包括颈5椎体的患者均被剔除研
究组。观察颈5神经根麻痹是否与患者的年龄、性别、术前是否接受过颈椎手术、术前身体状况、糖尿病、吸烟、减压范围及术前
是否有上肢疾病等多因素比较是否具有统计学差异。结果在375名患者中，60名患者被剔除，315名患者纳入研究，包括146
名女性患者和169名男性患者，平均年龄57.7岁（39~72岁）。本研究中颈5神经根麻痹的总发生率为6.03%（19/315），在各手术
组别中，颈椎后路椎板切除减压、植骨融合内固定组发生率最高，为8.62%；其次为颈椎前路椎体次全切除植骨融合内固定术+
后路减压植骨融合内固定组，为7.79%；前路椎体次全切除植骨融合内固定组为4.68%；后路椎板成形植骨融合组为3.85%，各
组别之间无统计学差异。男性患者较女性更易出现颈5神经根麻痹（8.28% vs 3.42%，P<0.05）。结论颈椎减压术后颈5神经根
麻痹的总发生率为6.03%，与之前报道结果接近。在各种颈椎减压手术方式之间颈5神经根麻痹的发生率无统计学差异，但颈
椎后路椎板切除减压、植骨融合内固定组中颈5神经根麻痹的发生率最高。

Incidences of C5 nerve palsy after multi-segmental cervical decompression through different approaches

Objective To investigate the incidence of C5 nerve root palsy after multi-segmental cervical decompression through
different approaches. Methods This study was conducted among 375 patients undergoing multi-segmental cervical
decompression in anterior corpectomy and fusion fixation, anterior cervical corpectomy and fusion fixation + posterior
decompression and fusion fixation, posterior cervical laminectomy decompression, fusion and internal fixation, and posterior
laminoplasty and fusion groups. The exclusion criteria included lack of follow-up data, spinal cord injury preventing
preoperative or postoperative motor testing, or surgery not involving the C5 level. The incidence of C5 palsy was determined
and the potential risk factors C5 palsy were analyzed including age, sex, revision surgery, preoperative weakness, diabetes,
smoking, number of levels decompressed, and a history of previous upper extremity surgery. Results Of the 375 patients, 60
patients were excluded and the data of 315 patients were analyzed, including 146 women and 169 men with a mean age of 57.7
years (range 39-72 years). The overall incidence of C5 nerve palsy was 6.03% (19/315) in these patients; in the subgroups
receiving different surgeries, the incidence was 8.62% in the cervical road laminectomy and fusion fixation group, 7.79% in the
anterior cervical corpectomy and fusion fixation + posterior decompression and fusion and internal fixation, 4.68% in the anterior
corpectomy and fusion fixation group, and 3.85% in the posterior laminoplasty and fusion group. No significant difference was
found in the incidences among the subgroups, but men were more likely than women to develop cervical nerve root palsy (8.28%
vs 3.42%, P<0.05). Conclusion The overall incidence of C5 nerve palsy following postoperative cervical spinal decompression
was 6.03% in our cohort. The incidence of C5 nerve palsy did not differ significantly following different cervical decompression
surgeries, but the incidence was the highest in the posterior cervical laminectomy and fusion and internal fixation group.