Significant reduction in the incidence of C5 palsy after cervical laminoplasty using chilled irrigation water
Significant reduction in the incidence of C5 palsy after cervical laminoplasty using chilled irrigation water
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DOI：
10.1302/0301-620x.98b1.36042
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发表时间：
2016-01-01
影响因子：
4.6
通讯作者：
Fuji, T.
中科院分区：
文献类型：
--
作者：
Takenaka, S.;Hosono, N.;Fuji, T.
目的基于临床上肢麻痹(ULP)是由于钻骨过程中摩擦产生的热量对神经根的热损伤所致，本研究的目的是确定冷灌洗生理盐水是否能降低临床上肢麻痹(ULP)的发生率(ULP：手动肌肉测试降低一级或以上；MMT)。方法400例患者(RT组)在开放式椎板成形术中使用室温(RT，25.6℃)的钻孔盐水，术中将400例患者的平均温度冷却至12.1℃(低温组)。我们用MMT评估三角肌、二头肌和三头肌的肌力。结果LT组的ULP发生率(4.0%vs 9.5%，p=0.003)，尤其是早发性瘫痪的发生率(1.0%vs 5.5%，p<；0.001)明显低于RT组。多因素分析显示，RT冲洗盐水的使用、同期椎孔切开和开放侧是ULP的显著预测因素。讨论在骨钻削中使用冷冻冲洗盐水显著降低了ULP的发生率，尤其是早发型，缩短了ULP的恢复期。因此，冷灌洗生理盐水可以被推荐为一种预防ULP的简单方法。带回家的信息：椎板成形术期间冷灌洗可减少C5瘫痪。
AimsThe aim of this study was to determine whether chilled irrigation saline decreases the incidence of clinical upper limb palsy (ULP; a reduction of one grade or more on manual muscle testing; MMT), based on the idea that ULP results from thermal damage to the nerve roots by heat generated by friction during bone drilling.MethodsIrrigation saline for drilling was used at room temperature (RT, 25.6 degrees C) in open-door laminoplasty in 400 patients (RT group) and chilled to a mean temperature of 12.1 degrees C during operations for 400 patients (low-temperature (LT) group). We assessed deltoid, biceps, and triceps brachii muscle strength by MMT. ULP occurring within two days post-operatively was categorised as early-onset palsy.ResultsThe incidence of ULP (4.0% vs 9.5%, p = 0.003), especially early-onset palsy (1.0% vs 5.5%, p < 0.001), was significantly lower for the LT group than for the RT group. Multivariate analysis indicated that RT irrigation saline use, concomitant foraminotomy, and opened side were significant predictors for ULP.DiscussionUsing chilled irrigation saline during bone drilling significantly decreased the ULP incidence, particularly the early-onset type, and shortened the recovery period for ULP. Chilled irrigation saline can thus be recommended as a simple method for preventing ULP.Take home message: Chilled irrigation during laminoplasty reduces C5 palsy.