射频消融髓核成形术治疗神经根型颈椎病疗效及相关因素分析  

Clinical efficacy of coblation nucleoplasty in treatment of cervical spondylotic radiculopathy and its influencing factors

作　　者：黄凯华[1] 吴志浩[1] 常伟 张子亮 于慧华 申璐璐 王贯通 孙强[1] HUANG Kaihua;WU Zhihao;CHANG Wei;ZHANG Ziliang;YU Huihua;SHEN Lulu;WANG Guantong;SUN Qiang(Department of Orthoprdics,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China;Department of Radiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)骨科,江苏南京210006 [2]南京医科大学附属南京医院(南京市第一医院)放射科,江苏南京210006

出　　处：《现代医学》2019年第6期682-687,共6页Modern Medical Journal

基　　金：中国博士后科学基金面上项目(2012M511301)

摘　　要：目的:观察射频消融髓核成形术治疗神经根型颈椎病的临床疗效,探讨影响疗效的相关因素。方法:回顾性分析2017年1月至2017年12月本院收治的72例神经根型颈椎病患者的临床资料,通过比较术前和术后不同时间点视觉模拟评分(VAS)、颈椎功能障碍指数(NDI)评估临床疗效,对比手术前后影像资料观察颈椎稳定性改变情况。对可能影响术后临床疗效的9种因素(年龄、性别、身体质量指数、病程、症状表现、椎间盘退变情况、是否合并椎管狭窄、手术时间、手术节段)进行单因素分析及多因素Logistic回归分析。结果:72例患者均顺利完成手术,手术时间15~50 min,平均28 min。与术前相比,患者术后各时间点的VAS评分显著降低(P<0.05),NDI指数显著提高(P<0.05)。末次随访时影像学表现与术前比较无明显差异(P>0.05)。依据改良MacNab标准评价末次随访疗效,优25例,良27例,可17例,差3例,优良率为72.2%。单因素分析显示,患者年龄、病程、症状表现、是否合并椎管狭窄、椎间盘退变情况等因素与疗效有显著性关系(P<0.05);多因素分析显示独立危险因素为病程、症状表现。结论:射频消融髓核成形术治疗神经根型颈椎病手术时间短,疗效好,安全性高,值得临床推广应用。病程、症状表现为影响手术疗效的独立因素,临床上应加以重视。Objective: To investigate the clinical efficacy of coblation nucleoplasty( CN) in the treatment of cervical spondylotic radiculopathy( CSR) and its influencing factors. Methods: 72 cases of CSR admitted from January 2017 to December 2017 were followed both clinically [by visual analogue scal( VAS) and neck disabilitv index( NDI)] and radiographically. Univariate analysis as well as multivariate Logistic regression analysis was performed on 9 kinds of factors( age,gender,body mass index,course of disease,symptoms,intervertebral disc degeneration,cervical central canal stenosis or not,operation time,surgical segment) that may affect the clinical efficacy. Results: 72 patients had been completed the operation successfully for an average of 28 minutes( 15-50 min). Compared with pre-operation,the VAS scores after operations at different points of time were significantly reduced and the NDI scores were significantly improved( P < 0. 05). No difference was found in imaging findings compared with pre-operation( P > 0. 05). According to the modified MacNab criteria,25 cases were excellent,27 cases good,17 cases fair and 3 cases poor,with excellent and good rate of 72. 2%. Single factor analysis showed that the age,duration,symptoms,intervertebral disc degeneration,cervical central canal stenosis or not had significant correlation with the curative effect( P < 0. 05). Multivariate Logistic regression analysis showed that the independent factors were duration and symptoms. Conclusion: Coblation nucleoplasty has advantages of short operative time,reliable efficacy and high security in treatment of CSR,it is worth popularizing application clinically. Duration and symptoms as independent factors should be paid attention to.

关 键 词：神经根型颈椎病 射频消融髓核成形术 临床疗效 影响因素 

分 类 号：R681.5[医药卫生—骨科学]