| 颈前路减压内固定术后C5神经根损伤的原因及预防 |
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Received:March 22, 2016
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| 作者 | Author | 单位 | Unit | E-Mail |
| 刘昱彰 |
LIU Yu-zhang |
中国中医科学院望京医院脊柱一科, 北京 100102 |
The First Department of Spinal Surgery, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 张世民 |
ZHANG Shi-min |
中国中医科学院望京医院脊柱一科, 北京 100102 |
The First Department of Spinal Surgery, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China |
smzhang1117@163.com |
| 董福慧 |
DONG Fu-hui |
中国中医科学院望京医院脊柱一科, 北京 100102 |
The First Department of Spinal Surgery, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 期刊信息：《中国骨伤》2016年29卷，第7期，第636-639页 |
| DOI：10.3969/j.issn.1003-0034.2016.07.010 |
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目的：对颈前路减压内固定术后C5神经根损伤原因进行分析，并探讨预防的手段。
方法：自 2005 年1 月至 2015年 12 月进行颈前路减压及融合手术310 例，对其中9 例术后出现C5神经根损伤的患者进行回顾性分析，男 8 例，女 1 例；年龄 51~84 岁，平均 64 岁。 内固定椎间融合手术节段：单节段为 2 例，双节段 6 例，3 节段 1 例。单纯三角肌无力及疼痛麻木7例，三角肌及肱二头肌同时无力及疼痛麻木2例。肌力0 级1 例，1 级 3例，2 级 4例，3 级1例。
结果：9 例患者术后随访均超过 12个月，最长为24个月，平均14个月。其中7例肌力恢复到 4~5 级。 术后恢复时间与损伤程度成正比，术后肌力在 2 级以上的患者3周之内有明显改善。JOA 评分术前10.89±1.89,术后发生 C5神经根麻痹时8.92±1.91,末次随访时14.48±2.10,差异有统计学意义（P < 0.05）.
结论：颈前路内固定术后C5神经根损伤的原因较为复杂，如果不存在严重碾挫伤及离断伤，多数患者可以获得满意的恢复。严格把握手术适应证，正确选择手术节段，操作准确轻柔，控制术中椎间隙撑开的幅度及椎体次全切的宽度等是预防此并发症的要素。 |
| [关键词]:颈前路内固定术 C5神经根损伤 肌肉麻痹 手术后并发症 |
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| The causes and prevention of C5 nerve root palsy after anterior cervical decompression and fusion |
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Abstract:
Objective: To analyze the causes of muscular paralysis due to C5 nerve root injury after anterior cervical decompression and fusion (ACDF) and explore its prevention way.
Methods: From January 2005 to December 2015, 310 patients underwent ACDF in our hospital. Of them, 9 cases occurred muscular paralysis due to C5 nerve root injury after operation. The clinical data of 9 patients were retrospectively analyzed. There were 8 males and 1 female, aged from 51 to 84 years with an average of 64 years. Two cases underwent internal fixation and intervertebral fusion with one segment, 6 cases with two segments, 1 case with three segments. Simple deltoid muscle weakness, pain, numbness happened in 7 cases, simultaneously biceps brachii muscle weakness, pain, numbness in 2 cases. Muscle strength was 0 grade in 1 case, 1 grade in 3 cases, 2 grades in 4 cases, 3 grades in 1 case.
Results: The follow-up time of 9 patients was more than 12 months and the longest was 24 months with an average of 14 months. Muscle strength of 7 patients recovered to 4-5 grades. Recovering time after operation was directly proportional to the degree of injury, those patients with muscle strength level more than 2, usually could have significant improvement within 3 weeks. The JOA score improved from 10.89±1.89 preoperatively to 8.92±1.91 postoperative C5 nerve root palsy to 14.48±2.10 at final follow-up, with significant difference(P < 0.05).
Conclusion: More complicated factors result in C5 nerve root injury after ACDF. Except those suffered severe grinding contusion and amputation, most of the patients can get satisfactory prognosis. Strict control of the operation indication, selection of the right surgical segment with accurate manipulation, control of the distraction of intervertebral space and the width of the multilevel anterior cervical corpectomy, are main methods to prevent the complication. |
| KEYWORDS:Anterior cervical decompression and fusion(ACDF) C5 nerve root injury Muscular paralysis Postoperative complications |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 刘昱彰,张世民,董福慧.颈前路减压内固定术后C5神经根损伤的原因及预防[J].中国骨伤,2016,29(7):636~639 |
| 英文格式: | LIU Yu-zhang,ZHANG Shi-min,DONG Fu-hui.The causes and prevention of C5 nerve root palsy after anterior cervical decompression and fusion[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(7):636~639 |
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