颈椎管狭窄椎板切除术疗效及并发症分析

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1、颈椎管狭窄椎板切除术疗效及并发症分析【摘要】目的探讨后路椎板减压治疗颈椎管狭窄症的疗效及术后并发症发生机制。方法经全椎板切除减压患者总计158例（减压范围均在3个节段以上），发生术后并发症而经再次前路手术或保守治疗者16例（A组）与未发生并发症者142例（B组），皆于手术前、后行脊髓功能JOA评分及体感神经诱发电位检查，随访时间2〜5年。结果A组患者于首次后路减压3个月后其上肢的下运动神经元通路损害症状逐渐缓解，A组和B组患者间的脊髓JOA评分改善程度、体感神经诱发电位波幅和潜伏期变动率在术前及术后2

2、年时间均无显著性差异，仅在术后3个月差异有显著性。结论后路手术后并发症系术中颈脊髓继发损伤致炎性反应加重，发生短暂脊髓组织可逆性再灌注损伤所致，经适当治疗可基本恢复；后路减压术后脊髓功能恢复与弓弦效应不呈正相关，而术后并发症发生却与其有一定关联。【关键词】体感神经诱发电位；JOA评分；弓弦效应；再灌注损伤Abstract：ObjectiveToinvestigatetheefficiencyofposteriordecompressionapproachforcervicalcompressivemy

3、elopathyandetiologyofpostoperative158casesfromtowhounderwentposteriorlaminectomywereenrolledforatleast2yearsandcomparedwiththeevaluationsystemsofJapaneseOrthopaedicAssociationScoreandsomatosensaryevokedessentialatdifferentpatients(Agroup)afterlaminectom

4、ywhotolerateddisturbanceofpostoperativecomplicationswereadministratedbysecondoperationorconservativeLesionoflowermotorneuronsandfinalcommonpathwayofupperlimbfromAgroupwerenotrelievedthroughabovementionedtreatmentuntil3monthsafterprimarytherecoveryrateof

5、JOAevaluationofspinalcordfunctionandalternationradioofwaveamplitudeandlatency,therewasnotsignificantdifferencebetween137sufferers(Bgroup)withoutpostoperativecomplicationsandAgroupatthepreoperativeperiodand2yearsafterfirstoperation，however，significantdif

6、ferenceexistedin3monthsafter:a)Weshouldnotgeneralizemostpostoperativecomplicationswithpalsyofcervical5spinalroot,theessenceofabovementionedsymptomsmaybereversiblysecondaryinjury(includingtemporaryinflammatoryreactionandreperfusioninjury)duetodecompressi

7、onprocess,whichwouldbealleviatedbyappropriateintervention；b)bowstringpotencyafterposteriordecompressionhadn'tpositivecorrelationtoextentoffunctionalrecovery,however,certainrelevanttopossibilityofpostoperativecomplications.Keywords：somatosensaryevokedess

8、ential；japaneseorthopeadicassociationscore；bowstringpotency；reperfusioninjury随着各种颈椎管后路减压术式的广泛开展，在减压时是否应联合应用内固定、何种术式造成颈椎失稳的可能性小且有利于脊髓功能恢复等问题上尚未形成共识。本文通过对非外伤性颈椎管狭窄后路减压病例观察，探讨单纯后路椎板减压效果，尝试从多角度评价术后脊髓功能改善效果及分析术后并发症的产生机理，以积累治疗颈椎管狭窄症的有益