本文選題：頸椎病 + 頸5神經(jīng)根麻痹��； 參考：《皖南醫(yī)學院》2017年碩士論文

【摘要】：目的:回顧9例頸椎減壓術(shù)后并發(fā)頸5神經(jīng)根麻痹癥患者的臨床資料。通過分析影像資料,探討頸椎前路減壓融合術(shù)后并發(fā)頸5神經(jīng)根麻痹癥的發(fā)病率,發(fā)病原因和發(fā)病危險因素以及預(yù)后。以期合理制定患者頸前路手術(shù)方案和判斷病人術(shù)后預(yù)后情況。方法:通過回顧并選取我院在2015年1月到2016年6月期間,因診斷為頸椎病來我科住院并接受頸椎前路減壓植骨融合手術(shù)的患者,共96例。按照術(shù)后肱二頭肌或(和)三角肌的肌力下降至少1級以上并且不伴有脊髓癥狀加重為診斷頸5神經(jīng)根麻痹的標準。并且按此標準,術(shù)后將患者分為A(出現(xiàn)頸5神經(jīng)根麻痹)組和B(無C5神經(jīng)根麻痹)組。記錄并比較兩組患者臨床資料如年齡、性別、病程、術(shù)前術(shù)后JOA評分、手術(shù)前后頸椎弧度變化、待減壓節(jié)段數(shù)、椎體撐開高度變化、C4/C5椎間孔前后徑、術(shù)前MRI圖像T2加權(quán)像C4/C5節(jié)段上是否合并局部高信號、手術(shù)時間和術(shù)中出血量等數(shù)據(jù)。建立多因素logistic回歸模型,分析頸5神經(jīng)根麻痹癥發(fā)病的危險因素。結(jié)果:所有患者均接受前路減壓融合手術(shù),術(shù)后有9例患者并發(fā)頸5神經(jīng)根麻痹,發(fā)病率為9.3%。其中5例來自頸椎前路椎體次全切植骨融合內(nèi)固定(ACCF)術(shù)后、2例來自頸椎前路椎間盤切除椎間融合內(nèi)固定(ACDF)術(shù)后、2例接受ACCF+ACDF即Hybrid聯(lián)合手術(shù)。其中6例患者經(jīng)營養(yǎng)神經(jīng)根、理療、高壓氧等對癥治療后肌力完全恢復(fù)至5級。其余恢復(fù)至4級。比較A、B兩組患者基本資料,發(fā)現(xiàn)性別、年齡、病程、術(shù)前JOA評分和手術(shù)時間、術(shù)中出血量參數(shù),無統(tǒng)計學差異(P0.05)。A組患者在手術(shù)前后生理弧度變化和椎間撐開高度變化、指標上大于B組,B組的椎間孔直徑大于A組,且具有統(tǒng)計學意義(P0.05)。Logistic多因素回歸分析模型提示C4/5椎間孔前后徑和手術(shù)前后頸椎生理曲度變化大小是頸5神經(jīng)根麻痹癥發(fā)生的危險因素。結(jié)論:C4/5椎間孔前后徑和手術(shù)前后頸椎生理曲度變化大小是頸椎前路減壓融合術(shù)后頸5神經(jīng)根麻痹癥發(fā)生的危險因素。而在臨床工作中,過度的矯正頸椎病患者頸椎生理弧度、盲目擴大減壓范圍術(shù)后更容易并發(fā)頸5神經(jīng)根麻痹。在制定頸椎病患者減壓方案時,和患者充分溝通,綜合考慮,權(quán)衡利弊做出最利于患者的手術(shù)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.
【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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本文編號：2006679