PTED与ACDF治疗单节段神经根型颈椎病的疗效评价  

Effect of PTED and ACDF for treatment of cervical spondylotic radiculopathy in single level

作　　者：郭骏[1] 胡攀[1] 刘欣伟[1] 任伟剑[1] 王洪伟[1] 陈语[1] 

机构地区：[1]沈阳军区总医院骨科,辽宁沈阳110016

出　　处：《中国骨与关节损伤杂志》2017年第1期1-5,共5页Chinese Journal of Bone and Joint Injury

基　　金：辽宁省科技计划面上项目(2015020403)

摘　　要：目的分析颈椎后路经椎间孔镜开窗减压髓核摘除术(PTED)与颈椎前路椎间盘切除融合术(ACDF)治疗神经根型颈椎病的临床疗效。方法回顾性分析自2013-05—2015-05分别采用PTED与ACDF治疗的45例神经根型颈椎病,PTED组15例,ACDF组30例。比较2组手术时间、术中出血量,术后3个月及末次随访时VAS评分、JOA评分、NDI指数、颈椎活动度,以及末次随访时SF-36评分。结果 PTED组14例、ACDF组27例获得9~26(15.6±5.1)个月随访。2组手术时间差异无统计学意义(P>0.05);但PTED组术中出血量较ACDF组少,差异有统计学意义(P<0.05)。术后3个月,PTED组邻近下位节段活动度较ACDF组小,颈椎整体活动度明显大于ACDF组,差异有统计学意义(P<0.05);但2组邻近上位节段活动度比较差异无统计学意义(P>0.05)。末次随访时,PTED组邻近上、下位节段活动度均小于ACDF组,差异有统计学意义(P<0.05);但2组颈椎整体活动度比较差异无统计学意义(P>0.05)。术后3个月PTED组VAS评分、JOA评分、NDI指数均较ACDF组改善明显,差异有统计学意义(P<0.05);但末次随访时2组比较差异无统计学意义(P>0.05)。结论 PTED与ACDF治疗单节段神经根型颈椎病临床疗效满意,PTED能有效保留颈椎活动度,减少邻近节段退变,值得临床推广应用。Objective To investigate the clinical efficacy of posterior percutaneous transforaminal endoscopic discectomy and anterior cervical discectomy with fusion for treatment of single level cervical spondylotic radiculopathy. Methods Forty-five cases of cervical spondylotic radiculopathy admitted from May 2013 to May 2015 were reviewed. Fifteen cases were treated by PTED while 30 cases were treated by ACDF. Operation time and estimated blood loss were compared between the 2 groups. VAS score, JOA score, NDI score and range-of-motion of cervical overall and adjacent intervertebral area were evaluated 3 months postoperatively and at final follow-up. The Chinese version of SF-36 scores was used in the assessment of life pre- and post-operation. Results A total of 41 patients（14 in PTED group and 27 in ACDF group） were followed up. The average duration of follow-up was （15.6±5.1）months, ranged from 9 to 26 months. No difference was found in the operation time between 2 groups （P 〉0.05）, the intraoperative blood loss was less in PTED group （P 〈0.05）. In PTED group, motion of lower adjacent intervertebral area was smaller and motion of cervical overall was bigger than that of ACDF group in 3 months after operation （P 〈0.05）, but in motion of upper adjacent intervertebral area there was no significant difference in two groups （P 〉0.05）. In PTED group, motion of adjacent intervertebral area was smaller than that of ACDF group at final follow-up （P 〈0.05）, but in motion of cervical overall there was no significant difference in two groups（P 〉0.05）. At 3 months after surgery, VAS, JOA and NDI scores were significantly improved in PTED group compared with the ACDF group （P 〈0.05）, no difference was found in final follow-up between 2 groups （P 〉0.05）. Conclusion PTED is a feasible alternative to ACDF for patients with cervical spondylotic radiculopathy. It can reduce the incidence of compensatory motion at adjacent segments and will prevent form adjacent segment degeneratio

关 键 词：神经根型颈椎病 颈椎后路经椎间孔镜开窗减压髓核摘除术 颈椎前路椎间盘切除融合术 颈椎活动度 

分 类 号：R681.5[医药卫生—骨科学]