颈椎前路减压手术治疗单侧肌萎缩型颈椎病的疗效分析

目的 探讨颈椎前路减压手术治疗单侧肌萎缩型颈椎病患者的临床疗效。方法 回顾性分析2005年1月—2014年1月河北医科大学第三医院脊柱外科行颈椎前路减压手术治疗的35例肌萎缩型颈椎病患者临床资料,其中男24例、女11例,年龄35~70岁,病程1~36个月,术后随访12~36个月(平均23.2个月)。依据肌肉萎缩最严重部位,将患者分为近侧型组(23例)和远侧型组(12例)。采用徒手肌力试验方法评估患者术前、术后肌力等级。行X线摄片、CT及MRI检查,观察并比较患者神经受累节段、术前脊髓信号强度的改变、神经受侵犯部位及患者肌力改善程度和时间。结果 近侧型组C_4/5水平最常受累(39.1%,9/23),远侧型组为C_5/6水平(10/12)。14例患者术前MRI T₂WI发现脊髓内信号增强。侵犯腹侧神经根的患者有24例、侵犯脊髓前角的29例,其中两者均受侵犯18例。术后肌力增加1级及以上者近侧型组达82.6%(19/23),而远侧型只有5/12(P=0.022)。近侧型组术后15 d内肌力改善的患者达56.5%(13/23),而远侧型无一例改善(Z=-3.255, P<0.01)。结论 颈椎前路减压手术对肌萎缩型颈椎病疗效肯定,而远侧型肌萎缩组疗效较差且恢复较慢。

The effects of anterior decompression surgery on unilateral cervical spondylotic amyotrophy

Objective To detect the effects of anterior decompression surgery on unilateral cervical spondylotic amyotrophy.Methods Thirty-five patients with unilateral cervical spondylotic amyotrophy treated by anterior decompression surgery at Spinal Surgery Department in the Third Hospital of Hebei Medical University from January 2005 to January 2014 were retrospectively studied. There were 24 males and 11 females. The mean following time after surgery was 23.2 months, ranged from 12 to 36 months. According to the most severely atrophic muscle, patients were divided into two groups: proximal-type group (n=23) and distal-type group (n=12). Manual muscle test was used to evaluate pre- and postoperative muscle strength. The affected intervertebral level, signal intensity change in the spinal cord, impingemented position of nerve by X-ray, CT and MRI, time and grades of improvement muscle strength were recorded and compared statistically.Results The most commonly affected intervertebral level in proximal-type patients and distal-type patients were C_4/5(39.1%, 9/23) and C_5/6(10/12), respectively. Signal intensity change in the spinal cord on MRI T₂WI was found in 14 patients before surgery. Twenty-four pantients impingemented against the ventral nerve root and 29 patients impingemented against the anterior horn, with 18 patients having both impingemented. The muscle power improvement on manual muscle testing gained 1 or more grades was 82.6%(19/23) in proximal-type group, whereas 5/12 in distal-type group (P=0.022). Fifty-six point five percent of proximal-type group had improvement of muse strength subjectively or objectively, whereas none of distal-type group had improvement, within 15 days after surgery (Z=-3.255, P<0.01).Conclusions Anterior decompression surgery is effective for most of patients with unilateral cervical spondylotic amyotrophy, but compared with the proximal-type patients, the distal-type patients gain inferior and slower postoperative recovery.