摘要
背景:有部分学者认为颈椎管狭窄症减压植入内固定后神经根麻痹与颈椎稳定性以及颈椎生理曲度有关,目前还存在争议。目的:探讨颈椎管狭窄症后路全椎板减压侧块内固定与单开门减压椎管扩大成形治疗后C_5神经根麻痹及稳定性。方法:选取29例颈椎管狭窄症患者进行后路减压植入物内固定治疗。方法①:颈椎管狭窄症后路全椎板减压侧块内固定,在C_(3-6)侧块以及C_7椎弓根钉内固定,关节突关节处造成粗糙面。方法②:根椐治疗前对正侧位平片及动力位片结合MRI、CT影像学图片,明确不稳定的节段,给予相应节段侧块内固定、椎板行单开门减压,椎管扩大成形治疗。结果与结论:29例颈椎管狭窄症患者随访8个月-2.3年,采用后路全椎板减压侧块内固定治疗的患者14例,植入后早期出现C_5神经根麻痹2例,远期症状复发出现不全瘫3例,二次手术行瘢痕切除减压治疗;采用单开门减压椎管扩大成形治疗的患者15例,治疗后出现C_5神经根麻痹肩外展功能不良1例,无治疗前症状复发病例。神经根麻痹最短6周,最长9个月均恢复。颈椎管狭窄症后路减压植入物内固定后,C_5神经根麻痹与节段稳定性、颈椎生理曲度、椎管减压程度、脊髓漂移范围是否相关以及发生程度、远期因瘢痕致再度出现椎管狭窄,两种治疗方式的区别是否有意义,目前病例数有限,有待病例及临床经验的积累与观察。
BACKGROUND： Some scholars suggest that the nerve root palsy after cervical spinal stenosis treated with decompression and implant internal fixation is related With the cervical stability and cervical lordosis, but there is controversial. OBJECTIVE： To explore the C5 nerve root palsy and stability after cervical spinal stenosis treated with posterior laminectomy lateral mass fixation and single-door decompression laminoplasty. METHODS： Twenty-nine cervical spinal stenosis patients were selected and treated with posterior decompression and implant internal fixation. Posterior laminectomy lateral mass fixation for the treatment of cervical spinal stenosis： C3-6 lateral mass and C7 pedicel screw internal fixation was performed and caused rough surface on the facet joint; the unstable segment was confirmed according to the preoperative anteraposterior plain film and dynamic radiographs combined with MRI and CT images, and then the corresponding segments were treated with lateral mass internal fixation, single-door decompression laminoplasty and laminoplasty.RESULTS AND CONCLUSION： All the 29 cervical spinal stenosis patients were followed-up for 8 months to 2.3 years. Among them, 14 cases were treated with posterior laminectomy lateral mass fixation, two cases had nerve root palsy in the early stage after implantation, three cases had incomplete paralysis after Iong2term symptom recurrence and treated with second surgery of scar remove and decompression; 15 Cases were treated with single-door decompression laminoplasty, and one case had Cs never root palsy and shoulder abduction dysfunctiopafter treatment, no preoperative symptom recurrence. The nerve mot palsy will restored in 6 weeks for shortest and 9 months for longest. As the limitation of the case number, it is not clear whether there were significant differences in the correlation between C5 nerve root palsy and segmental stability, cervical lordosis, spinal decompression degree and the range for spinal cord shift, as well as the nerve mot palsy degre
出处
《中国组织工程研究》
CAS
CSCD
2013年第35期6345-6350,共6页
Chinese Journal of Tissue Engineering Research
