颈椎减压术后C5神经根麻痹症状恢复时间的影响因素

摘要

目的 探讨颈椎减压术后影响C5神经根麻痹恢复时间的临床及影像学因素.方法 回顾性分析沈阳军区总医院骨科脊柱病区接受颈椎减压手术的710例患者的临床资料,记录患者的人口统计学、放射学及临床信息,分析其与术后C5麻痹恢复时间的相关性.结果 36例患者术后发生C5神经根麻痹,其中33例患者术后2年内C5神经麻痹完全恢复(18例患者术后6个月内恢复),3例患者在随访时间内C5神经根麻痹未完全恢复.术后C5神经根麻痹恢复时间超过6个月的影响因素有:术后四肢肌力小于等于2级(P＜0.01)、除C5神经根以外的多个节段神经根麻痹(P =0.002)、痛觉与躯体感觉的缺失(P =0.008)以及脊髓移动的程度(P=0.040);多因素相关性分析显示,术后肌力小于等于2级(P =0.010)是C5神经根麻痹恢复时间超过6个月的最重要因素.结论 术后四肢肌力小于等于2级、除C5神经根以外的多个节段神经根麻痹、痛觉与躯体感觉的缺失以及脊髓移动的程度为影响C5神经根麻痹恢复时间是否超过6个月的主要因素.%Objective To evaluate the clinical and radiological factors which affecting the recovery duration of C5 palsy after cervical decompression surgery.Methods The datas of 710 patients with degenerative cervical spine surgery in departement of spine surgery of orthopaedics of general hospital of Shenyang military region were retrospectively analyzed.The demographics,radiology,clinical information were recorded to analyze the relationship with the recovery duration of postoperative C5 palsy.Results C5 nerve root palsy occurred in 36 cases,of which 33 cases completely recovered within 2 years after surgery(18 cases recovered within postoperative 6 months),3 cases did not completely recovered during the following period.Factors related to longer recovery(over 6 months) included postoperative limbs muscles strength ≤2(P＜0.01),presence of multi-segment paresis involving more than the C5 root(P =0.002),loss of somatic sensation with pain(P =0.008),and the degree of posterior spinal cord shifting (P =0.040).Furthermore,multivariate analysis revealed that postoperative limbs muscles strength ≤2(P =0.010) had a significant effect on a recovery duration beyond 6 months.Conclusion The postoperative limbs muscles strength ≤2,the presence of multi-segment paresis involving more than the C5 root,the loss of somatic sensation with pain,and the degree of posterior spinal cord shifting are main factors which significantly influence the duration of recovery from postoperative C5 nerve root palsy.