颈椎前路减压术后颈5神经根麻痹相关风险分析

发布时间：2018-06-11 21:00

本文选题：颈椎病 + 颈5神经根麻痹　；参考：《皖南医学院》2017年硕士论文

【摘要】：目的:回顾9例颈椎减压术后并发颈5神经根麻痹症患者的临床资料。通过分析影像资料,探讨颈椎前路减压融合术后并发颈5神经根麻痹症的发病率,发病原因和发病危险因素以及预后。以期合理制定患者颈前路手术方案和判断病人术后预后情况。方法:通过回顾并选取我院在2015年1月到2016年6月期间,因诊断为颈椎病来我科住院并接受颈椎前路减压植骨融合手术的患者,共96例。按照术后肱二头肌或(和)三角肌的肌力下降至少1级以上并且不伴有脊髓症状加重为诊断颈5神经根麻痹的标准。并且按此标准,术后将患者分为A(出现颈5神经根麻痹)组和B(无C5神经根麻痹)组。记录并比较两组患者临床资料如年龄、性别、病程、术前术后JOA评分、手术前后颈椎弧度变化、待减压节段数、椎体撑开高度变化、C4/C5椎间孔前后径、术前MRI图像T2加权像C4/C5节段上是否合并局部高信号、手术时间和术中出血量等数据。建立多因素logistic回归模型,分析颈5神经根麻痹症发病的危险因素。结果:所有患者均接受前路减压融合手术,术后有9例患者并发颈5神经根麻痹,发病率为9.3%。其中5例来自颈椎前路椎体次全切植骨融合内固定(ACCF)术后、2例来自颈椎前路椎间盘切除椎间融合内固定(ACDF)术后、2例接受ACCF+ACDF即Hybrid联合手术。其中6例患者经营养神经根、理疗、高压氧等对症治疗后肌力完全恢复至5级。其余恢复至4级。比较A、B两组患者基本资料,发现性别、年龄、病程、术前JOA评分和手术时间、术中出血量参数,无统计学差异(P0.05)。A组患者在手术前后生理弧度变化和椎间撑开高度变化、指标上大于B组,B组的椎间孔直径大于A组,且具有统计学意义(P0.05)。Logistic多因素回归分析模型提示C4/5椎间孔前后径和手术前后颈椎生理曲度变化大小是颈5神经根麻痹症发生的危险因素。结论:C4/5椎间孔前后径和手术前后颈椎生理曲度变化大小是颈椎前路减压融合术后颈5神经根麻痹症发生的危险因素。而在临床工作中,过度的矫正颈椎病患者颈椎生理弧度、盲目扩大减压范围术后更容易并发颈5神经根麻痹。在制定颈椎病患者减压方案时,和患者充分沟通,综合考虑,权衡利弊做出最利于患者的手术方案。
[Abstract]:Objective: to review the clinical data of 9 patients with cervical 5 nerve root palsy after cervical decompression. The incidence, causes, risk factors and prognosis of cervical 5 nerve root paralysis after anterior cervical decompression fusion were analyzed. The purpose of this study was to make a reasonable plan of anterior cervical surgery and to judge the prognosis of patients after operation. Methods: from January 2015 to June 2016, 96 patients with cervical spondylosis were treated by anterior decompression and bone graft fusion. The criteria for the diagnosis of cervical 5 nerve root paralysis were the reduction of muscle strength of biceps brachii or / and deltoid muscle at least one grade after operation and no exacerbation of spinal cord symptoms. According to this standard, patients were divided into group A (cervical 5 nerve root paralysis) and group B (no C 5 nerve root paralysis). The clinical data of the two groups were recorded and compared, such as age, sex, course of disease, JOA score before and after operation, the changes of cervical curvature before and after operation, the number of segments to be decompressed, the changes of vertebral body opening height and the anterior and posterior diameter of intervertebral foramen C4 / C5. Whether local hyperintensity, operative time and intraoperative bleeding were combined on T 2 weighted MRI images of C4 / C5 segment before operation. Multivariate logistic regression model was established to analyze the risk factors of cervical 5 nerve root paralysis. Results: all the patients received anterior decompression and fusion surgery. 9 cases were complicated with cervical 5 nerve root palsy. The incidence was 9.3%. Among them, 5 cases came from anterior subtotal vertebral body fusion and internal fixation (ACCF). 2 cases came from anterior cervical intervertebral disc resection and intervertebral fusion fixation (ACDF) and 2 cases received ACCF ACDF hybrid combined operation. The muscle strength of 6 patients recovered to grade 5 after treatment with nutritional nerve root, physiotherapy and hyperbaric oxygen. The rest is restored to level 4. The basic data of patients in group A and B were compared. Sex, age, course of disease, preoperative JOA score, time of operation, parameters of intraoperative bleeding, no significant difference were found in the changes of physiological arc and intervertebral distraction height before and after operation in group A (P 0.05). The diameter of intervertebral foramen in group B was larger than that in group A. The multivariate logistic regression analysis showed that the anterior and posterior diameter of intervertebral foramen of C4 / 5 and the change of physiological curvature of cervical vertebrae before and after operation were the risk factors of cervical 5 nerve root palsy. Conclusion the anterior and posterior diameter of intervertebral foramen and the change of physiological curvature of cervical spine before and after operation are the risk factors of cervical 5 nerve root paralysis after anterior cervical decompression and fusion. In clinical work, excessive correction of cervical spine physiological radians and blind expansion of decompression range are more likely to be complicated with cervical 5 nerve root paralysis. When making decompression plan for patients with cervical spondylopathy, communicate fully with patients, consider comprehensively, weigh the advantages and disadvantages to make the best surgical plan for patients.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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