后路全内镜手术治疗单节段后外侧型颈椎间盘突出症的短期疗效观察  

Study on the short- term therapeutic effects of the full- endoscopic technique on single segmental posterior lateral cervical disc herniation

作　　者：李进[1] 孔维军[1] 季文军[1] 覃建朴[1] 敖俊[1] 廖文波[1] 

机构地区：[1]遵义医学院附属医院脊柱外科,贵州遵义563099

出　　处：《遵义医学院学报》2016年第2期170-174,共5页Journal of Zunyi Medical University

基　　金：贵州省科技厅联合基金资助项目(NO:黔科合LH字[2015]7491)

摘　　要：目的观察后路全内镜颈椎间盘切除术(Posterior Full-Endoscopic Cervical Disectomy,PFECD)治疗单节段后外侧型颈椎间盘突出症的短期疗效。方法 2015年8月至11月,对10例确诊为单节段后外侧型颈椎间盘突出症的患者,于全麻下行后路全内镜颈椎间盘突出髓核靶向摘除、神经根减压术。记录患者术前1 d及术后1 d、1周、1月JOA、VAS评分,末次随访改良Macnab评价其临床疗效,全部病例复查颈椎MRI、三维CT。结果所有患者均成功完成手术并得到短期随访,无相关手术并发症发生,症状明显改善。术前与术后各时间点JOA及VAS评分进行比较,差异具有统计学意义(P<0.05)。术前1 d与末次随访时上肢运动、感觉功能JOA评分比较(P<0.05),差异具有统计学意义。依据改良Macnab疗效评定标准评估其临床疗效,其中优8例,良2例,可0例,差0例。术后复查颈椎MRI、三维CT重建提示突出椎间盘充分切除,神经根无明显受压;三维CT重建提示打磨患侧关节突的范围都未超过整个关节突的1/2。结论后路全内镜手术治疗单节段后外侧型颈椎间盘突出症是一种安全、可行、有效的微创手术方法,值得深入研究及广泛应用。Objective To observe the short- term effects of the Posterior Full- Endoscopic Cervical Disectomy（ PFECD） on the posterior lateral cervical disc herniation. Methods From August,2015 to November,2015,ten cases diagnosed with single segmental posterior lateral cervical intervertebral disc herniation received the nucleus pulposus targeted excision and nucleus root decompression in the posterior full endoscopic cervical intervertebral disc herniation. The JOA and VAS scores 1 day before the surgery and 1week and 1 month after the surgery were recorded. The modified Macnab criteria at the last follow- up was also recorded. All cases were given the cervical MRI and three dimensional CT cervical spine. Results All operations were successful and all patients were short- term followed up. No related complications occurred and the symptoms were significantly improved. The statistically significant difference of JOA and VAS scores between the preoperative and postoperative time was shown（ P 〈 0. 05）. The statistically significant difference of JOA score in the function of upper limb movement feeling between 1 day before surgery and the last follow- up was indicated（ P 〈 0. 05）. In terms of the modified Macnab,there were 8 excellent cases and 2 good cases. Postoperative cervical spine MRI review and three- dimensional CT reconstruction showed the adequate resection of intervertebral disc with no obvious compression of the nerve root. Three- dimensional CT reconstruction tip grinding range of lateral articular process didn’t exceed the half of articular process. Conclusion PFECD in the treatment of the posterior single segmental lateral type cervical intervertebral disc herniation is a safe,feasible and effective minimally invasive surgery method and worthy of further research and a wide range of application.

关 键 词：颈椎间盘突出症 全内镜技术 神经根减压 临床疗效 

分 类 号：R681.5[医药卫生—骨科学]