经皮激光汽化椎间盘减压术治疗颈椎病的远期疗效评价  

LONG-TERM EFFECTIVENESS OF PERCUTANEOUS LASER DISC DECOMPRESSION IN TREATMENT OF CERVICAL SPONDYLOSIS

作　　者：秦辉[1,2] 李康仁[1,2] 范善均[1,2] 薛力[1,2] 邱学勇[1,2] 余彬[1,2] 高参[1,2] 陈坚[1,2] 

机构地区：[1]重庆医科大学附属成都第二临床学院 [2]成都市第三人民医院骨科,成都610031

出　　处：《中国修复重建外科杂志》2010年第12期1485-1488,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的研究经皮激光汽化椎间盘减压术(percutaneous laser disc decompression,PLDD)治疗颈椎病的远期疗效和影响因素。方法 2003年3月-2005年6月,采用PLDD治疗156例颈椎病患者。男74例,女82例;年龄31～74岁,平均55.4岁。病程2个月～15年。神经根型59例,椎动脉型48例,脊髓型19例,混合型30例。突出椎间盘节段:C3、432个,C4、566个,C5、689个,C6、769个;单节段71例,多节段85例。采用多因素logistic回归分析远期疗效及影响因素。结果术后即刻117例(75%)术前症状减轻或缓解。术后3d1例(0.64%)发生椎间盘炎,使用抗生素3周后痊愈。患者均获随访,随访时间5年～7年3个月,平均5年6个月。末次随访时疗效按Macnab标准评价,获优60例(38.46%),良65例(41.67%),中19例(12.18%),差12例(7.69%),优良率80.13%。82例X线片检查示末次随访椎体角度位移、水平位移与术前比较,差异均无统计学意义(P>0.05)。多因素logistic回归分析显示,年龄、病程对远期疗效有影响(P<0.05),而颈椎病类型、椎间盘突出程度、轻度颈椎不稳及病变节段因素对远期疗效无影响(P>0.05)。结论 PLDD治疗各型颈椎病安全、有效,并发症少,且不影响脊柱的稳定性。远期疗效受年龄、病程影响较明显,而与颈椎病分型、颈椎间盘突出程度、轻度颈椎不稳及病变节段等因素无明显相关性。Objective To retrospectively analyze the long-term effectiveness of percutaneous laser disc decompression （PLDD） in treatment of cervical spondylosis. Methods Between March 2003 and June 2005, 156 patients with cervical spondylosis were treated with PLDD. There were 74 males and 82 females with an average age of 55.4 years （range, 31-74 years）. The disease duration varied from 2 months to 15 years. Fifty-nine patients were classifi ed as cervical spondylotic radiculopathy, 48 as vertebral-artery-type cervical spondylosis, 19 as cervical spondylotic myelopathy, and 30 as mixed type spondylosis. The lesions were located at the levels of C3,4 in 32 discs, C4,5 in 66 discs, C5,6 in 89 discs, and C6,7 in 69 discs, and including 71 one-leve lesion and 85 multi-level lesions. All cases were followed up to study the long-term effectiveness and correlative factors. Results A total of 117 （75%） patients’ symptoms were lightened or eased up immediately after operation. Discitis occurred in 1 case at 3 days after operation and was cured after 3 weeks of antibiotic use. All patients were followed up 5 years to 7 years and 3 months （5 years and 6 months on average）. According to Macnab criteria, the long-term effectiveness was excellent in 60 cases （38.46%）, good in 65 cases （41.67%）, fair in 19 cases （12.18%）, and poor in 12 cases （7.69%）; the excellent and good rate was 80.13%. No significant difference was observed in the wedge angels and displacements of the intervertebral discs between before and after operations （P 0.05）. Multiple-factors logistic regression showed that the disease duration and patient’s age had obvious relationship with the effectiveness of treatment （P 0.05）, while the type of cervical spondylosis, disc protrusion degree, mild cervical instability, and lesion scope had no correlation with the effectiveness of treatment （P 0.05）. Conclusion PLDD is safe and effective in treatment of cervical spondylosis with less complication. There is no impact on the sta

关 键 词：颈椎病 经皮激光汽化椎间盘减压术 远期疗效 影响因素 

分 类 号：R687.3[医药卫生—骨科学]