Chung Jae-Yoon, Park Jong-Beom, Chang Han, Song Kyung-Jin, Kim Jin-Hyok, Hong Chang-Hwa, Lee Jung Sub, Lee Sang-Hun, Song Kwang-Sup, Yang Jae Jun, Uh Jae-Hyung, Kim Young-Tae, Lee Jae Min
Cervical Spine Study Group, Korean Society of Spine Surgery, Seoul, Korea.
Cervical Spine Study Group, Korean Society of Spine Surgery, Seoul, Korea. ; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea.
Asian Spine J. 2015 Oct;9(5):694-8. doi: 10.4184/asj.2015.9.5.694. Epub 2015 Sep 22.
Retrospective multicenter study.
We aimed to investigate prognostic factors affecting postsurgical recovery of deltoid palsy due to cervical disc herniation (CDH).
Little information is available about prognostic factors affecting postsurgical recovery of deltoid palsy due to CDH.
Sixty-one patients with CDH causing deltoid palsy (less than grade 3) were included in this study: 35 soft discs and 26 hard discs. Average duration of preoperative deltoid palsy was 11.9 weeks. Thirty-two patients underwent single-level surgery, 22 two-level, four three-level, and three four-level. Patients with accompanying myelopathy, shoulder diseases, or peripheral neuropathy were excluded from the study.
Deltoid palsy (2.4 grades vs. 4.5 grades, p<0.001) and radiculopathy (6.4 points vs. 2.1 points, p<0.001) significantly improved after surgery. Thirty-six of 61 patients (59%) achieved full recovery (grade 5) of deltoid palsy, with an average time of 8.4 weeks. Longer duration of preoperative deltoid palsy and more severe radiculopathy negatively affected the degree of improvement in deltoid palsy. Age, gender, number of surgery level, and disc type did not affect the degree of improvement of deltoid palsy. Contrary to our expectations, severity of preoperative deltoid palsy did not affect the degree of improvement. Due to the shorter duration of preoperative deltoid palsy, in the context of rapid referral, early surgical decompression resulted in significant recovery of more severe grades (grade 0 or 1) of deltoid palsy compared to grade 2 or 3 deltoid palsy.
Early surgical decompression significantly improved deltoid palsy caused by CDH, irrespective of age, gender, number of surgery level, and disc type. However, longer duration of deltoid palsy and more severe intensity of preoperative radiating pain were associated with less improvement of deltoid palsy postoperatively.
回顾性多中心研究。
我们旨在研究影响颈椎间盘突出症（CDH）所致三角肌麻痹术后恢复的预后因素。
关于影响CDH所致三角肌麻痹术后恢复的预后因素，目前信息较少。
本研究纳入了61例因CDH导致三角肌麻痹（低于3级）的患者：35例软性椎间盘患者和26例硬性椎间盘患者。术前三角肌麻痹的平均持续时间为11.9周。32例患者接受了单节段手术，22例接受了双节段手术，4例接受了三节段手术，3例接受了四节段手术。伴有脊髓病、肩部疾病或周围神经病变的患者被排除在研究之外。
术后三角肌麻痹（2.4级对4.5级，p<0.001）和神经根病（6.4分对2.1分，p<0.001）有显著改善。61例患者中有36例（59%）三角肌麻痹完全恢复（5级），平均恢复时间为8.4周。术前三角肌麻痹持续时间较长和神经根病较严重对三角肌麻痹的改善程度有负面影响。年龄、性别、手术节段数量和椎间盘类型不影响三角肌麻痹的改善程度。与我们的预期相反，术前三角肌麻痹的严重程度不影响改善程度。由于术前三角肌麻痹持续时间较短，在快速转诊的情况下，与2级或3级三角肌麻痹相比，早期手术减压使更严重等级（0级或1级）的三角肌麻痹有显著恢复。
早期手术减压显著改善了CDH所致的三角肌麻痹，与年龄、性别、手术节段数量和椎间盘类型无关。然而，三角肌麻痹持续时间较长和术前放射性疼痛强度较严重与术后三角肌麻痹改善较少相关。
