经皮颈椎后路内镜颈椎间盘切除术处理侧椎管骨性狭窄疗效分析  

linical results and analysis of osteophyte removal within lateral spinal canal through posterior percutaneous endoscopic cervical discectomy

作　　者：李瑞[1] 王光林[1] 任佳彬[1] 刘鑫[1] 王红艳 孙宁[1] 黄镇 孙兆忠[1] LI Rui;WANG Guang-lin;REN Jia-bin;LIU Xin;WANG Hong-yan;SUN Ning;HUANG Zhen;SUN Zhao-zhong(Department of Spine Surgery,affiliated Hospital of Binzhou Medical University,Yantai,Shandong,256603,China)

机构地区：[1]滨州医学院附属医院脊柱外科,山东256603 [2]滨州医学院附属医院疼痛科,山东256603

出　　处：《中国骨与关节杂志》2019年第12期925-930,共6页Chinese Journal of Bone and Joint

基　　金：山东省自然科学基金(ZR2017LH021)

摘　　要：目的对比经皮颈椎后路内镜颈椎间盘切除术(posterior percutaneous endoscopic cervical discectomy,PPECD)处理软性颈椎间盘突出和侧椎管骨性狭窄两类情况临床的治疗效果、并发症及短期随访,总结手术技巧及经验。方法回顾性分析 2016 年 2 月至 2018 年1月,25 例于我院诊断为神经根型颈椎病并行 PPECD 的患者,根据患者术中探查取出突出物为软性髓核或侧椎管增生骨赘,分为髓核组(17 例)和骨赘组(8 例),术后系统随访至少 3 个月。术前行颈椎正侧位、过伸过屈位 X 线片,术前 48 h 内行颈椎 CT 脊髓造影(computed tomography myelography,CTM)进一步明确突出位置。术前 24 h 内统计疼痛视觉模拟评分(visual analog scale,VAS)、颈椎功能障碍指数(neck disability index,NDI)。术后统计患者手术时间、住院日、并发症。统计患者术后 8 h、3天、14 天、3个月的 VAS 评分。统计术后 3 个月 NDI 指数。结果 25 例均完成短期随访。髓核组、骨赘组平均年龄分别为(53.65±2.13)岁、(62.75±2.14)岁,骨赘组平均年龄高于髓核组,差异有统计学意义(P=0.015)。髓核组、骨赘组平均手术时间分别为(56.41±1.60)min、(97.75±5.28)min,骨赘组平均手术时间高于髓核组,差异有统计学意义(P<0.001)。髓核组、骨赘组平均住院日分别为(10.18±1.06)天、(14.00±1.39)天,骨赘组平均住院日高于髓核组,差异有统计学意义(P=0.047)。髓核组术前和术后 8 h、3天、14 天、3个月 VAS 评分分别为 6.46±0.23、1.59±0.32、2.10±0.40、2.14±0.37、2.15±0.35,骨赘组分别为 6.06±0.27、2.00±0.50、2.50±0.45、2.38±0.54、2.19±0.52,两组术后 3 个月 VAS 评分均较术前显著降低,差异有统计学意义(P<0.001);两组之间 VAS 评分差异无统计学意义(P>0.05)。髓核组术前和术后 3 个月 NDI 指数分别为 48.12±1.46、19.88±3.93,骨赘组分别为 47.25±2.78、23.50±5.90。两组术后 3 个月 NDI 指数较术前显著降低,差�Objective To compare the clinical results between soft disc herniation and osteophyte removal within lateral spinal canal after posterior percutaneous endoscopic cervical discectomy (PPECD). Methods From February 2016 to January 2018, 25 patients diagnosed with cervical spondylotic radiculopathy were performed PPECD. All were divided into two groups according to soft nucleus pulposus (nucleus pulposus group, n=17) and osteophyte (osteophyte group, n=8). A standard 3-months follow-up was completed. Anteroposterior, lateral and flexion-extension (FE) radiographs were needed and the definite locations of herniations were ensured from computed tomography myelography within 48 hours before the surgery. VAS was collected within 24 hours preoperatively and at 8 hours, 3 days, 14 days, 3 months postoperatively. NDI was collected within 24 hours preoperatively and at 3 months postoperatively. The operation duration, hospital stay and complications were collected and statistically analyzed after the surgery. Results The mean age of the osteophyte group was significantly higher than that in the nucleus pulposus group[(62.75±2.14) y vs. (53.65±2.13) y, P=0.015]. The mean oparation duration of the osteophyte group was longer than that in the nucleus pulposus group[(97.75±5.28) min vs. (56.41±1.60) min, P<0.001], which showed significant differences between the 2 groups. The mean hospital stay of the osteophyte group was significant longer than that of the nucleus pulposus group[(14.00±1.39) d vs. (10.18±1.06) d, P=0.047]. The VAS of nucleus pulposus group before operation and at 8 hours, 3 days, 14 days, 3 months after operation were (6.46±0.23),(1.59±0.32), (2.10±0.40), (2.14±0.37), (2.15±0.35), respectively. The VAS of osteophyte group before operation and at 8 hours, 3 days, 14 days, 3 months after operation were (6.06±0.27), (2.00±0.50), (2.50±0.45),(2.38±0.54), (2.19±0.52), respectively. The VAS of each group showed significant decrease after 3 months(P<0.001), but there were no significant differences be

关 键 词：脊柱疾病 颈椎 内窥镜 最小侵入性外科手术 

分 类 号：R687.3[医药卫生—骨科学]