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Anatomical and experimental investigntion on postoperative ralimlopattiy after postenior decompresion of the cervical spinal cord

颈髓减压术后颈椎病术后恢复的解剖学和实验研究

基本信息

批准号：
05807135
负责人：
TSUZUKI Nobuyuki
金额：
$ 1.28万
依托单位：
Saitama Medical School
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (C)
财政年份：
1993
资助国家：
日本
起止时间：
1993 至 1995
项目状态：
已结题

项目摘要

Based on anatomical and clinical studies on the cervical spinal cord and root using 20 Japanese adults and 118 patients, the following facts were elucidated. 1) There were two possible sites for the occurrence of post-decompressive tethering effects on cervical roots, i.e., intradural and extraural. 2) Extradural tethering effect could be induced by exertion of dural traction force on extradural roots which were anchored to the intervertebral foramina by perineural adhesion, resulting in traction injury of extradural roots. 3) Anatomical characteristics of intra-and extradural portions of a root indicated that the extradural tethering effect might be the most probable cause of post-operative palsy and it was verified by a clinical study. 4) As methods of prevention for each of these tethering effects, a longitudinal durotomy was effectivi in reducing extradural tehthering effect and a suppression of posterior enlargement of dural tube to that degree that allowed intradural rootlets remain relaxd was thought to be effective for prevention of intradural tethering effect. In another series of posterior decompression consisting with 43 patients, dural pressures just posterior to C5 root-sleeve were measured using a 2-9 nylon thread with a diameter of 0.3mm. of nine patients with a dural perssure higher than 40 g-weight/mm^2,4patients developed post-operative C5 palsy. Of twenty nine patients with a dural pressure lower than 40 g-weight/mm^2, one patient developed post-operative C5 palsy. There was a difference of statistical significance (X^2=4.35, p<0.05) between those two groups. This result showed that measurement of dural pressure during surgery might be useful to detect a possibility of post-operative palsy. Further studies are required to develop a more accurate method for predicting post-operative palsy and a simpler method of prevention of it than a longitudinal durotomy.

根据对 20 名日本成年人和 118 名患者进行的颈脊髓和根部的解剖学和临床研究，阐明了以下事实。 1）颈根减压后栓系效应发生的可能部位有两个，即硬膜内和硬膜外。 2)对通过神经周粘连固定在椎间孔上的硬膜外根施加硬膜牵引力，可引起硬膜外系留效应，导致硬膜外根牵引损伤。 3）根部硬膜内和硬膜外部分的解剖特征表明，硬膜外系留效应可能是术后麻痹的最可能原因，并得到了临床研究的验证。 4)作为预防这些束缚效应的方法，纵向硬脑膜切开术对于减少硬膜外束缚效应是有效的，并且将硬脑膜管后部扩大抑制到允许硬膜内细根保持松弛的程度被认为对于预防硬膜内束缚效应是有效的。在另一组由 43 名患者组成的后路减压中，使用直径为 0.3mm 的 2-9 尼龙线测量 C5 根套后方的硬脑膜压力。 9 名硬脑膜压力高于 40 g-weight/mm^2 的患者中，4 名患者出现术后 C5 麻痹。在 29 名硬脑膜压力低于 40 g-weight/mm^2 的患者中，一名患者出现术后 C5 麻痹。两组之间存在统计学差异（X^2=4.35，p<0.05）。这一结果表明，手术期间测量硬脑膜压力可能有助于检测术后麻痹的可能性。需要进一步的研究来开发一种比纵向硬脑膜切开术更准确的预测术后麻痹的方法和更简单的预防方法。