颈椎Key-hole技术与颈前路Zero-P系统治疗神经根型颈椎病的病例对照研究  

A case-control study of cervical spine Key-hole technique and anterior cervical Zero-P system in the treatment of cervical spondylotic radiculopathy

作　　者：王放[1] 李杰[1] 刁攀 李锋涛[1] 王栋[1] 李浩鹏[1] 贺西京[1] WANG Fang;LI Jie;DIAO Pan;LI Feng-tao;WANG Dong;LI Hao-peng;HE Xi-jing(The Second Department of Orthopaedics,the Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,Shaanxi,China)

机构地区：[1]西安交通大学第二附属医院骨二科,陕西西安710004

出　　处：《中国骨伤》2021年第1期33-39,共7页China Journal of Orthopaedics and Traumatology

基　　金：国家自然科学基金(编号:81701223);陕西省自然科学基金(编号:2017JQ8019);中央高校基本科研业务费专项资金资助(编号:1191329737)。

摘　　要：目的:探讨脊柱内镜下颈后路开窗减压髓核摘除术(Key-hole)和颈前路零切迹椎间植骨融合内固定系统(zero profile intervertebral fusion system,Zero-P)治疗单节段神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的短期临床疗效。方法:回顾性分析2017年1月至2020年1月因神经根型颈椎病行手术治疗的45例患者,根据不同的手术方式分为Key-hole组和Zero-P组,其中Key-hole组21例(男12例,女9例),随访时间10~22(13.2±2.3)个月;Zero-P组24例(男14例,女10例),随访时间10~23(12.7±1.9)个月。比较两组手术的围手术期情况(手术切口长度、术中出血量、手术时间、住院时间、并发症情况等),分别于术前和术后即刻及末次随访时拍摄颈椎正侧位X线片评价颈椎曲度,并根据手术前后疼痛视觉模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry Disability Index,ODI)以及颈椎日本骨科协会(Japanese Orthopaedic Association,JOA)评分来评价临床疗效。结果:Key-hole组与Zero-P组手术切口长度、术中出血量、手术时间、末次随访Cobb角度及术后即刻VAS评分分别为(1.2±0.2)cm,(5.3±0.3)cm;(35.3±9.7)ml,(120.2±13.5)ml;(56.4±11.3)min,(90.6±12.6)min;(3.2±3.9)°,(7.3±3.8)°;(2.8±1.2)分,(3.8±1.1)分;Zero-P组均大于Key-hole组(P<0.05)。两组患者住院时间、ODI及JOA评分组间比较差异无统计学意义(P>0.05)。术后随访Key-hole组出现1例神经刺激症状经保守治疗缓解,2例因颈椎间盘突出复发再次手术治疗后好转;Zero-P组出现2例神经刺激症状,2例咽部不适,1例硬脊膜撕裂,均经保守治疗缓解。结论:颈椎Key-hole技术与颈前路Zero-P系统治疗神经根型颈椎病疗效相近,Key-hole技术在切口长度、术中出血、手术时间上有一定优势,是一种安全、有效、可以深度推广和运用的颈椎手术方式。Objective:To explore the short-term clinical efficacy of single-stage cervical spondylotic radiculopathy(CSR)between the minimally invasive Key-hole technique and anterior cervical Zero profile intervertebral fusion system(Zero-P).Methods:A retrospective analysis was performed on 45 patients who underwent surgical treatment for CSR from January 2017 to January 2020,including 21 in Key-hole group(12 males and 9 females),followed up for 10-22(13.2±2.3)months;24 cases in Zero-P group(14 males and 10 females),and the follow-up period was 10 to 23(12.7±1.9)months.Perioperative conditions(incision length,intraoperative blood loss,operation time,length of hospital stay,and complications)were compared between two groups,and X-rays of cervical spine before and after surgery and at the final follow-up were taken to analyzed curvature of the cervical spine,visual analogue scale(VAS)of pain before and after surgery,Oswestry Disability Index(ODI)and Japanese Orthopaedic Association(JOA)score of cervical spine were recorded to evaluate clinical efficacy.Results:In Key-hole group and Zero-P group,the surgical incision length,intraoperative blood loss,operation time,final follow-up Cobb angle and immediate postoperative VAS score respectively were(1.2±0.2)cm,(5.3±0.3)cm;(35.3±9.7)ml,(120.2±13.5)ml;(56.4±11.3)min,(90.6±12.6)min;(3.2±3.9)°,(7.3±3.8)°;(2.8±1.2)points,(3.8±1.1)points;the Zero-P group was larger than the Key-hole group,with statistical significance(P<0.05).There were no statistically significant difference in length of hospital stay,ODI and JOA scores between two groups(P>0.05).After the follow-up,1 case of neurostimulation symptoms in Key-hole group was relieved by conservative treatment,2 cases improved after reoperation due to recurrence of cervical disc herniation;2 cases of neurostimulation symptoms in Zero-P group,2 cases of throat discomfort,and 1 case dural tears were all relieved by conservative treatment.Conclusion:The cervical spine Key-hole technology is similar to the anterior cervical Zero

关 键 词：颈椎病 外科手术 内窥镜 脊柱融合术 减压术 外科 

分 类 号：R681.5[医药卫生—骨科学]