Zhang Jing Tao, Yang Da Long, Shen Yong, Zhang Ying Ze, Wang Lin Feng, Ding Wen Yuan
Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Orthopedics. 2012 Dec;35(12):e1792-7. doi: 10.3928/01477447-20121120-26.
Cervical spondylotic amyotrophy is a rare clinical condition. The purpose of this study was to investigate the effects of anterior decompression in patients with unilateral upper-extremity amyotrophy caused by cervical spondylosis. The authors retrospectively analyzed the records of 31 patients (23 men and 8 women) who underwent anterior decompressive surgery for cervical spondylotic amyotrophy at the authors' institution between 2000 and 2011. Demographic characteristics, pre- and postoperative results of imaging studies, and postoperative muscle power improvement were reviewed at a mean follow-up of 22.2 months (range, 14-36 months). Patients were divided into proximal (n=21) and distal (n=10) types according to the most severely atrophic muscle, and the 2 groups were compared statistically. The most commonly affected intervertebral level in proximal-type patients was C4-C5, whereas that in distal-type patients was C5-C6. Impingements against the ventral nerve root and anterior horn were observed in 22 and 25 cases, respectively, with 16 cases having both impingements. Eighty-one percent of proximal-type patients gained 1 or more grades of muscle power improvement on manual muscle testing, whereas 40% of distal-type patients improved. Within 15 postoperative days, 57% of proximal-type patients attained subjective or objective improvement of muscle power, whereas all distal-type patients failed to improve. Anterior decompression was effective for most patients with unilateral cervical spondylotic amyotrophy, although postoperative muscle power improvement in distal-type patients was inferior to that in proximal-type patients. Furthermore, compared with the proximal type, the distal type showed a slower postoperative recovery.
颈椎病性肌萎缩是一种罕见的临床病症。本研究的目的是探讨前路减压术对颈椎病所致单侧上肢肌萎缩患者的疗效。作者回顾性分析了2000年至2011年间在作者所在机构接受颈椎病性肌萎缩前路减压手术的31例患者（23例男性和8例女性）的记录。在平均随访22.2个月（范围14 - 36个月）时，回顾了人口统计学特征、影像学研究的术前和术后结果以及术后肌力改善情况。根据最严重萎缩的肌肉将患者分为近端型（n = 21）和远端型（n = 10），并对两组进行统计学比较。近端型患者最常受累的椎间水平为C4 - C5，而远端型患者为C5 - C6。分别在22例和25例中观察到腹侧神经根和前角受压，其中16例同时存在两种受压情况。81%的近端型患者在徒手肌力测试中肌力提高了1级或更多级，而远端型患者中40%有改善。术后15天内，57%的近端型患者肌力获得主观或客观改善，而所有远端型患者均未改善。前路减压术对大多数单侧颈椎病性肌萎缩患者有效，尽管远端型患者术后肌力改善不如近端型患者。此外，与近端型相比，远端型术后恢复较慢。
