后路内镜下半椎板切除术治疗脊髓型颈椎病  

Posterior endoscopic hemilaminectomy for cervical spondylotic myelopathy

作　　者：甄瑞鑫[1] 常成兵 赵龙[1] 杨佳宁[1] 李玉波[1] 安永胜[1] 陈宾[1] ZHEN Rui-xin;CHANG Cheng-bing;ZHAO Long;YANG Jia-ning;LI Yu-bo;AN Yong-sheng;CHEN Bin(The Second Department of Spine Surgery,Affiliated Hospital,Chengde Medi-cal College,Chengde 067000,China)

机构地区：[1]承德医学院附属医院脊柱二科,河北承德067000

出　　处：《中国矫形外科杂志》2021年第9期848-851,共4页Orthopedic Journal of China

摘　　要：[目的]介绍后路内镜下半椎板切除术治疗脊髓型颈椎病的手术技术和初步临床结果。[方法]2017年1月~2019年10月,对7例脊髓型颈椎病患者采用后路内镜下半椎板切除减压术。在症状重的一侧插入导针,透视定位。行小切口,置入工作套筒,用磨钻头去除椎板,小心去除黄韧带,至硬膜囊膨起,搏动良好。[结果]7例患者均顺利完成手术,术中未出现任何血管、脊髓及神经根损伤情况。随访18个月以上。相较于术前,术后上肢和下肢VAS评分显著降低(P<0.05),而颈椎JOA评分显著升高(P<0.05)。影像方面,术后患者颈椎受累节段均表现出半椎板切除后征象,硬脊膜及神经根受压解除。随访期内均未出现颈椎病变节段及其邻近节段椎间隙狭窄、退变,未见颈椎不稳征象。[结论]后路内镜下半椎板切除术医源性创伤小,安全可靠,是治疗脊髓型颈椎病的一种可选择的方法。[Objective]To introduce the surgical technique and preliminary clinical outcomes of posterior endoscopic hemilaminectomy for the treatment of cervical spondylotic myelopathy.[Methods]From January 2017 to October 2019,7 patients underwent posterior endoscopic hemilaminectomy and decompression for cervical spondylotic myelopathy.After inserting a guide pin on the side with symptoms under fluoroscopic monitoring,a small incision on the pin was made,and then a working channel was placed.The hemilamina was removed with a drill bit,and the ligamentum flavum was carefully removed until the dural sac exposed with proper pulsation.[Results]The 7 patients had surgical procedures carried out smoothly,with no damage to blood vessels,spinal cord and nerve roots during the operation.The patients were followed up for more than 18 months.The VAS scores of upper and lower limbs significantly decreased(P<0.05),while the JOA scores for the cervical spine significantly increased postoperatively compared with those preoperatively(P<0.05).In terms of imaging assessment,the affected segments of the cervical spine presented hemilaminectomy change with proper decompression of the dura sac and nerve roots after operation.During the follow-up period,there was no stenosis or degeneration on the affected cervical segment and the adjacent segments,and no signs of cervical spine instability was found.[Conclusion]Posterior endoscopic hemilaminectomy is safe and reliable procedure with less iatrogenic trauma,which maybe a choice for the treatment of cervical spondylotic myelopathy.

关 键 词：脊髓型颈椎病 颈椎后路内镜术 半椎板切除术 

分 类 号：R681.55[医药卫生—骨科学]