颈后路脊柱内镜治疗神经根型颈椎病1年随访研究  

The clinical outcome of posterior cervical endoscopic discectomy in patients with cervical spondylotic radiculopathy:A 1-year follow-up

作　　者：陈志瑞 吴彬彬[2] 杨明浩 胡屹鹭 衡冰冰 刘佳[5] 占恭豪[2] 饶高峰 CHEN Zhi-Rui;WU Bin-Bin;YANG Ming-Hao;HU Yi-Lu;HENG Bing-Bing;LIU Jia;ZHANGong-Hao;RAO Gao-Feng(Department of Rehabilitation,the First People's Hospital of Wenling,Taizhou 317500,China;Department of Pain Medicine,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,China;Department of Anesthesiology,the Second Medical School of Wenzhou Medical University,Wenzhou 325000,China;Department of Anesthesiology,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,China;Department of Rehabilitation,Taizhou Center Hospital,Taizhou 318000,China)

机构地区：[1]温岭市第一人民医院康复科,台州317500 [2]温州医科大学附属第二医院疼痛科,温州325027 [3]温州医科大学第二临床医学院麻醉学系,温州325000 [4]温州医科大学附属第二医院麻醉科,温州325027 [5]台州市中心医院康复科,台州318000

出　　处：《中国疼痛医学杂志》2020年第11期832-837,共6页Chinese Journal of Pain Medicine

基　　金：温州市科技局课题(Y20160392);温岭市科技局课题(2020S0180118)。

摘　　要：目的:探索颈后路脊柱内镜治疗神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的安全性和术后疗效。方法:纳入“神经根型颈椎病”诊断明确并于2017年1月至2018年10月在我科接受颈后路脊柱内镜手术治疗的病人68例,术后随访1年,记录所有病人性别、年龄、疼痛持续时间、手术节段、手术时间、术中并发症、住院天数等。在术前、术后1天、7天、1月、3月、6月和1年采用数字评分法(numeric rating scales,NRS)评估疼痛,Oswestry功能障碍指数(Oswestry disability index,ODI)和日本骨科协会评分量表(Japanese orthopaedic association,JOA)评估功能恢复;在术后1年随访中采用改良Macnab评估病人临床预后。结果:68例病人中男性36例、女性32例,平均年龄55.4±11.2岁,疼痛持续平均时间为114.5±23.5周。手术节段为C3-44例、C4-515例、C5-636例、C6-712例、C5-6和C6-71例,手术平均时间为78.1±9.6 min,平均住院天数为4.3±1.6天。所有病人完成术后1年临床疗效随访。术后各时间点颈肩部和上肢疼痛NRS评分较术前显著降低(P˂0.01),术后ODI指数和JOA评分均显著低于术前(P˂0.01)。术后1年随访68例病人中有38例为“优”、20例“良”、9例“可”、1例“差”,“优良率”达85.3%。均无发生神经根损伤、硬膜囊撕裂或感染等并发症,且无病人因症状复发需要接受二次微创或开放手术治疗。结论:颈后路脊柱内镜为治疗CSR的一种有效且安全的手术方式,可有效改善症状和病人生活质量。Objective:The purpose of this study was to explore the long-term clinical outcome of posterior cervical endoscopic discectomy in the patients with cervical spondylotic radiculopathy(CSR).Methods:A total of 68 patients diagnosed with CSR received posterior cervical endoscopic discectomy in the department of Pain Medicine of the Second Affiliated Hospital of Wenzhou Medical University between January 2017 and October 2018 were enrolled.All patients'gender,age,pain duration,operation level,operation time,complication,and hospital stay were recorded.The numeric rating scales(NRS),Oswestry disability index(ODI),and Japanese orthopaedic association scores(JOA)were adopted to assess the pain and dysfunction of patients at pre-operation,postoperative 1 d,7 d,1 m,3 m,6 m and 1-year.In addition,the modified Macnab was used to evaluate the prognosis of the patients at the last visit.Results:There were 36 males and 32 females with an average age of 55.4±11.2 years and an average pain duration of 114.5±23.5 weeks.4 cases operated on C3-4,15 cases on C4-5,36 cases on C5-6,12 cases on C6-7 and 1 case on C5-6 and C6-7.The average operation time was 78.1±9.6 min,and the mean hospital stay was 4.3±1.6 days.All patients finished the postoperative 1-year follow up.Compared with pre-operation,the NRS pain rating of the postoperative neck and shoulder pain,and upper limb pain were significantly decreased at all postoperative time points(P<0.01).The ODI and JOA scores were also reduced after the operation at all time points compared with pre-operation(P<0.01).There were 38 cases evaluated with"excellent",20 cases were"good",9 cases were"fair",and 1 case was"poor".The overall satisfactory rate was 85.3%.Cases with nerve root injury,epidural tear or infection were never found.None of the patients needed a second surgery treatment because of recurrence.Conclusion:The posterior cervical endoscopic discectomy was demonstrated to be an effective and safe therapy of CSR,which can significantly relieve pain with a good clinical outcome.How

关 键 词：颈后路 脊柱内镜 神经根型颈椎病 微创 临床疗效 

分 类 号：R687.3[医药卫生—骨科学]