多节段脊髓型颈椎病经颈后路不同术式治疗后C5神经根麻痹的观察对比

目的 分析颈后路单开门椎管成形术与椎板切除内固定术治疗多节段脊髓型颈椎病术后C5神经根麻痹的发生率及其原因.方法 2008年1月至2012年8月因多节段脊髓型颈椎病分别接受椎管成形术的患者47例（A组）、接受椎板切除内固定术的患者51例（B组）,术后随访13～56（26.5±7.9）个月.手术前后分别测量颈椎前凸角度、颈椎曲度指数（CCI）,并记录术后C5神经根麻痹的发生情况.结果 A组C5神经根麻痹发生率明显低于B组[2.1％（1/47）比21.6％（11/51）],差异有统计学意义（x2=5.430,P＜0.05）.A、B组手术前后日本整形外科学会（JOA）评分和术后JOA评分改善率比较差异均无统计学意义（P＞0.05）.各组手术前后颈椎前凸角度及CCI比较差异无统计学意义（P＞0.05）.A组和B组CCI改变率比较差异无统计学意义（P＞0.05）.B组中发生C5神经根麻痹11例作为B1组,另40例为B2组.B1组术后CCI改变率要明显大于B2组[（38.7±18.3）％比（22.1±12.1）％],差异有统计学意义（t=1.772,P＜0.05）.结论 相比颈后路椎板切除内固定术,椎管成形术后C5神经根麻痹发生率低.C5神经根麻痹可能与颈后路术后颈椎前凸增加有关.神经根拴系效应是其重要的发病机制之一.

Comparative observation of C5 nerve root palsy after posterior surgical treatment of multilevel cervical spondylotic myelopathy

Objective To compare the incidence of Cs nerve root palsy after laminoplasty and laminectomy with internal fixation for treating multilevel cervical spondylotic myelopathy（MCSM）. Methods From January 2008 to August 2012,98 patients with MCSM were treated with laminoplasty （47 patients, group A ） or lamineetomy （51 patients, group B ） with internal fixation. All the patients were followed up for 13 - 56（ 26.5 ± 7.9 ） months. In both groups, Cobb＇s method was applied to measure cervical lordotic angle, and Ishihara＇s method was conducted to measure cervical curvature index （CCI） before and after operation. The incidence of C5 nerveroot palsy was recorded and compared. Results The incidence of C5 nerve root palsy in group A was 2.1% （ 1/47 ）, while 21.6 % （ 11/51 ） in group B （ A; = 5.430, P 〈 0.05 ）. The JOA scores in group A and group B before and after operation and improvement rate of JOA scores had no significant difference （P〉 0.05）. The cervical lordotic angle and CCI in group A and group B before and after operation had no significant difference （P 〉 0.05 ）. The improvement rate of CCI between two groups had no significant difference （P 〉 0.05 ）. All of 11 patients with C5 nerve root palsy were group B 1, and other 40 patients were group B2. The improvement rate of CCI in group B1 was significantly higher than that in group B2 [ （38.7 ±18.3 ） % vs. （22.1 ± 12.1 ） % ] （t = 1.772, P 〈 0.05 ）. Conclusions Compared with laminoplasty, laminectomy with internal fixation has a higher incidence of C5 nerve root palsy. The C5 nerve root palsy may be associated with postoperative increase of cervical lordosis angle. Moreover,tethering of the C5 root may he one of its important pathomeehanisms.