内镜下微创颈椎管成形术"诱导"突出颈椎间盘自然吸收的初步观察  

A preliminary observation on the natural absorption of cervical intervertebral disc in the"induction"of protrusion by minimally invasive cervical tracheoplasty under endoscopy

作　　者：李莹[1] 李龙[1] 严旭[1] 李东哲[1] 王永魁 董超 曹争明 张春霖[1] Li Ying;Li Long;Yan Xu;Li Dongzhe;Wang Yongkui;Dong Chao;Cao Zhengming;Zhang Chunlin(Department of Orthopaedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院骨科,450052

出　　处：《中国实用医刊》2020年第10期15-19,共5页Chinese Journal of Practical Medicine

基　　金：国家自然科学基金青年科学基金项目(81802128)。

摘　　要：目的:观察内镜下微创颈椎管成形术"诱导"突出颈椎间盘自然吸收的情况。方法:抽取2016年1月至2019年1月郑州大学第一附属医院治疗的脊髓型颈椎病(CSM)患者36例,根据临床症状分为保守治疗组和内镜下微创颈椎管成形术组(CMEL组)。保守治疗组18例,男7例,女11例;手术治疗组18例,男10例,女8例。所有患者均进行随访,应用PACS软件对突出颈椎间盘体积进行测量分析,以一定指标及日本骨科协会评估治疗分数(JOA评分)分别评估突出颈椎间盘自然吸收(RHNP)的情况和临床疗效。结果:36例患者均获得随访,随访时间为0.23~36.00(17.31±11.19)个月。以5%作为测量误差的标准:保守治疗组与CMEL组突出颈椎间盘的吸收率和吸收比例分别为6.79%±0.66%、36.65%±29.90%及2/18、13/18,差异有统计学意义(P<0.001);保守治疗组和CMEL组突出颈椎间盘的再突出比率分别为64.91%和5.56%,差异均有统计学意义(P<0.001);末次随访时临床疗效保守治疗组和CMEL组优良比分别为13/18和16/18。结论:CMEL术后早期即能广泛"诱导"突出的颈椎间盘发生RHNP,提示CMEL术式可以减少或避免联合一期行颈前路椎间盘切除术,提高手术治疗的安全性及疗效,从而为CSM治疗提供新的更为合理可靠的策略及依据。Objective To observe the natural absorption of the protruding cervical intervertebral disc in the"induction"of protrusion by minimally invasive cervical laminoplasty under endoscopy.Methods From January 2016 to January 2019,36 patients with cervical spondylotic myelopathy were selected from the First Affiliated Hospital of Zhengzhou University.According to the clinical symptoms,they were divided into two groups:conservative treatment group and endoscopic minimally invasive cervical laminoplasty group(CMEL group).In the conservative treatment group,there were 18 cases,7 males and 11 females;in the operative treatment group,there were 18 cases,10 males and 8 females.All the patients were followed up.PACS software was used to measure and analyze the volume of herniated cervical intervertebral disc.The correlation and Japan orthopaedic association assessment treatment score(JOA score)were used to evaluate the natural absorption of herniated cervical intervertebral disc(RHNP)and its clinical effect.Results Thirty-six patients were followed up for 0.23~36.00(17.31±11.19)months.Taking 5% as the standard of measurement error:the absorption rate and the absorption ratio of the conservative treatment group and CMEL group were 6.79%±0.66%,36.65%±29.90%,2/18 and 13/18 respectively,the difference was statistically significant(P<0.001);the ratio of protrusion of cervical intervertebral disc in conservative treatment group and CMEL group was 13/18 and 16/18,respectively,the difference was statistically significant(P<0.001).Conclusions It is suggested that CMEL can reduce or avoid the combination of one-stage anterior cervical discectomy,improve the safety and efficacy of surgery,so as to provide a more reasonable and reliable strategy and basis for CSM treatment.

关 键 词：脊髓型颈椎病 内镜下微创颈椎管成形术 突出颈椎间盘 

分 类 号：R687.3[医药卫生—骨科学]