后纵韧带骨化症颈后路椎管成形术后C5神经根麻痹的临床分析

目的 探讨后纵韧带骨化症颈椎后路椎管成形术后C₅神经根麻痹的原因。方法 回顾性分析。纳入2013年1月—2017年10月徐州市中心医院后纵韧带骨化症患者132例,其中男68例、女64例,年龄39~79（58.6±8.8）岁,节段型31例、连续型40例、混合型61例,均采用颈后路椎管成形术治疗。根据患者术后是否有C₅神经根麻痹分为麻痹组13例,非麻痹组119例。对比分析2组患者基线资料;分别于术前和术后1个月进行日本骨科协会（JOA）评分,并评估患者神经功能改善率;测量2组患者手术前后颈椎曲度和颈椎曲度指数（CCI）,并计算术前术后颈椎曲度和CCI的变化;分析颈椎骨化类型、C_3/4或C_4/5 MRI脊髓信号改变的组间差异。结果 麻痹组与非麻痹组患者年龄、性别、骨化类型等基线资料比较差异均无统计学意义（P值均>0.05）,术前、术后1个月JOA评分以及术后改善率组间比较差异均无统计学意义（P值均>0.05）。2组患者术前、术后的颈椎曲度和CCI比较,差异均无统计学意义（P值均>0.05）。麻痹组患者手术前后颈椎曲度变化值为5.02°±6.53°,高于非麻痹组的1.21°±6.58°;麻痹组患者手术前后CCI变化值为5.59%±7.38%,高于非麻痹组的1.35%±5.65%：差异均有统计学意义（t=-1.98、-2.49,P值均<0.05）。非麻痹组患者术前C_3/4或C_4/5在MRI上显示脊髓信号改变的患者比例（20/119）少于麻痹组（7/13）,差异有统计学意义（χ²=7.74,P=0.005）。结论 术前术后较大的颈椎曲度和CCI的变化、C_3/4或C_4/5MRI上显示脊髓信号改变均可能对后纵韧带骨化症颈后路椎管成形术后产生C₅神经根麻痹造成影响。

Risk factors of C5 nerve root palsy after laminoplasty in patients with ossification of posterior longitudinal ligament

Objective This study aims to explore the influence of different factors of C₅ nerve root paralysis after posterior cervical laminoplasty for ossification of posterior longitudinal ligament. Methods A retrospective analysis was performed from January 2013 to October 2017 on 132 patients with ossification of the posterior longitudinal ligament treated with posterior cervical laminoplasty in Xuzhou Central Hospital. Participants were composed of 68 male and 64 female patients aged 39 to 79 years, with an average age of (58.6±8.8) years. The study included 31 segmental, 40 continuous, and 61 mixed cases. Patients were divided into palsy (13 cases) and nonparalysis (119 cases) groups. Baseline data of the two groups were compared and analyzed. Japanese Orthopedic Association (JOA) score was performed before surgery and 1 month after surgery. Pre- and postoperative cervical curvatures and cervical curvature index (CCI) were measured. Types of cervical ossification and changes in C_3/4 or C_4/5 MRI spinal cord signals were examined between groups. Results Differences between the two groups in terms of age, gender, and ossification type were insignificant (all P values >0.05). Differences in the JOA score and postoperative improvement rate between groups before and 1 month after surgery were insignificant (all P values >0.05). However, changes in the cervical curvature before and after operation of the paralytic group were 5.02°±6.53°, which was higher than that in the nonparalytic group (1.21°±6.58°). The CCI of patients with paralysis before and after operation was 5.59%±7.38%, which was higher than that of patients without paralysis (1.35%±5.65%). Differences were statistically significant (t=-1.98, -2.49; all P values<0.05). The proportion of patients with C_3/4 or C_4/5 preoperative spinal cord signal changes in the MRI of the nonparalytic group (20/119) was less than that of the paralytic group (7/13), and the difference was statistically significant (χ²=7.74,P=0.005). Conclusions ignificant pre- and postoperative changes in cervical curvature and CCI as well as changes in spinal cord signals shown in the C_3/4 or C_4/5 MRI may influence the occurrence of C₅ nerve root palsy after posterior cervical laminoplasty for ossification of the posterior longitudinal ligament.