颈椎前路减压融合术后颈5神经根麻痹的影响因素及其预测价值

doi:10.3760/cma.j.issn.1007-1245.2024.18.004

摘要/Abstract

摘要：

目的　分析颈椎前路减压融合术后颈5（C₅）神经根麻痹的影响因素及其预测价值。方法　回顾性选取2019年1月至2022年8月期间商洛市中心医院收治的468例颈椎前路减压融合术患者作为研究对象，其中男241例，女227例，年龄（46.79±10.06）岁。所选患者均进行为期1年的随访，根据是否发生C₅神经根麻痹分为发生组（42例）和未发生组（426例）。收集并整理所选患者的临床、影像资料，使用单因素分析（χ²检验、t检验）、多因素logistic回归分析相关影响因素，并构建预测模型分析预测价值。结果　发生组术后C_4/5椎间隙高度［（9.05±0.44）mm］及C₃_～₅脊髓高信号患者占比［42.86%（18/42）］均高于未发生组［（8.12±0.61）mm、8.22%（35/426）］，术前C_4/5椎间孔横径小于未发生组［（3.01±0.56）mm比（4.10±0.79）mm］，C_4/5水平脊髓旋转角度（SRA）大于未发生组［（6.14±0.85）°比（3.46±0.52）°］，差异均有统计学意义（均P<0.001）。术后C_4/5椎间隙高度高、术前C_4/5椎间孔横径小、C_4/5水平SRA大、C₃_～₅脊髓高信号是颈椎前路减压融合术后患者C₅神经根麻痹的独立危险因素（OR=2.408、2.489、2.757、2.214，均P<0.05）。预测模型受试者操作特征曲线（ROC）的曲线下面积（AUC）为0.916（95%CI：0.887～0.940）。结论　颈椎前路减压融合术后患者发生C₅神经根麻痹与术后C_4/5椎间隙高度高、术前C_4/5椎间孔横径小、C_4/5水平SRA大、C₃_～₅脊髓高信号有关，据此构建的预测模型具有一定的预测价值。

关键词:

颈椎前路减压融合术, 颈5神经根麻痹, 危险因素, 预测模型, 预测价值

Abstract:

Objective　To analyze the influencing factors and their predictive value of cervical 5 (C₅) nerve root palsy after anterior cervical decompression and fusion surgery. Methods　A total of 468 patients with anterior cervical decompression and fusion admitted to Shangluo Central Hospital between January 2019 and August 2022 were selected for the study, including 241 males and 227 females, aged (46.79±10.06) years. The selected patients were followed up for 1 year and were divided into an occurrence group (42 cases) and a non-occurrence group (426 cases) based on whether they were accompanied by C₅ nerve root palsy. The clinical and imaging data of the selected patients were collected and sorted. Univariate analysis (χ² test and t test) and multiple logistic regression analysis were used to analyze the relevant influencing factors, and the prediction model was constructed to analyze the predictive value. Results　The postoperative height of the C_4/5 intervertebral foramen [(9.05±0.44) mm] and proportion of the patients with high signal intensity in the C_3-5 spinal cord [42.86% (18/42)] in the occurrence group were higher than those in the non-occurrence group [(8.12±0.61) mm and 8.22% (35/426)], the preoperative transverse diameter of the C_4/5 intervertebral foramen was smaller than that in the non-occurrence group [(3.01±0.56) mm vs. (4.10±0.79) mm], and the horizontal spinal cord rotation angle (SRA) was larger than that in the non-occurrence group [(6.14±0.85)° vs. (3.46±0.52)°], with statistically significant differences (all P<0.001). The independent risk factors for C5 nerve root palsy after anterior cervical decompression and fusion were high postoperative height of the C_4/5 intervertebral foramen, small preoperative transverse diameter of the C_4/5 intervertebral foramen, large SRA at the C_4/5 level, and high signal intensity of the C_3-5 spinal cord (OR=2.408, 2.489, 2.757, and 2.214, all P<0.05). The area under the curve (AUC) of the predictive model's receiver operating characteristic curve was 0.916 (95%CI: 0.887-0.940). Conclusions　C₅ nerve root palsy in patients after anterior cervical decompression and fusion were associated with high height of the C_4/5 intervertebral space, small transverse diameter of the C_4/5 intervertebral foramen, high SRA at the C_4/5 level, and high signal intensity of the C_3-5 spinal cord. The prediction model constructed based on this had certain predictive value.

Key words:

Anterior cervical decompression and fusion surgery, Cervical 5 nerve root palsy, Risk factors, Prediction model, Predictive value

李敏郭一帆.

颈椎前路减压融合术后颈5神经根麻痹的影响因素及其预测价值 [J]. 国际医药卫生导报, 2024, 30(18): 3008-3012.

Li Min, Guo Yifan.

Influencing factors and their predictive value of cervical 5 nerve root palsy after anterior cervical decompression and fusion surgery [J]. International Medicine and Health Guidance News, 2024, 30(18): 3008-3012.

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