三维体积法评价内镜下微创颈椎管成形术后不同退变程度突出颈椎间盘的自然吸收  

Evaluation of natural resorption of herniated cervical intervertebral disc with different degrees of degeneration after cervical microendoscopic laminoplasty by three-dimensional volume method

作　　者：李龙[1] 张春霖[1] 邵成龙 严旭[1] 王永魁 刘小康[1] 李东哲[1] Li Long;Zhang Chunlin;Shao Chenglong;Yan Xu;Wang Yongkui;Liu Xiaokang;Li Dongzhe(Department of Orthopedics,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan Province,China)

机构地区：[1]郑州大学第一附属医院骨科,河南省郑州市450000

出　　处：《中国组织工程研究》2021年第36期5832-5837,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:既往研究认为突出颈椎间盘的自然吸收现象与突出的类型和位置有关,突出颈椎间盘的退变程度是否会影响其发生自然吸收现象尚不清楚。目的:观察内镜下微创颈椎管成形术后不同退变程度的突出颈椎间盘发生自然吸收的情况,并分析其特点及可能的机制,为脊髓型颈椎病治疗提供更为合理的策略和依据。方法:回顾性分析郑州大第一附属医院2014年1月至2020年1月行内镜下微创颈椎管成形术治疗的54例脊髓型颈椎病患者的一般资料及影像学资料。采用Miyazaki分级标准评估突出颈椎间盘退变程度并分组;应用三维体积法测量患者术前及末次随访时突出颈椎间盘的体积,采用吸收率、吸收比评估突出颈椎间盘发生自然吸收的情况;采用日本骨科协会评分评价临床疗效。结果与结论:(1)54例患者均获得随访,其中男29例,女25例,年龄(54.81±9.76)岁,病程(10.54±8.48)个月,随访时间10 d至76个月;(2)共观察到159个突出颈椎间盘,其中87.42%(139/159)发生不同程度的吸收;(3)因Ⅰ,Ⅴ级退变组数量较少,不纳入统计学分析;Ⅱ、Ⅲ、Ⅳ级退变组的吸收率和吸收比分别为(40.60±25.72)%、(36.12±18.30)%、(37.49±27.95)%及85.42%(41/48)、89.23%(58/65)、87.50%(35/40),各组间差异无统计学意义(P>0.05);(4)139个发生自然吸收的突出颈椎间盘中有77.70%(108/139)无退变等级变化,另有22.30%(31/139)发生退变等级增加,其中Ⅱ级变Ⅲ级22个,Ⅲ级变Ⅳ级9个;(5)54例患者疗效优者20例,良27例,可7例,优良率87%;(6)结果表明内镜下微创颈椎管成形术后突出颈椎间盘的自然吸收现象与突出颈椎间盘退变程度无关,提示该术式使脊髓型颈椎病患者不同退变程度的突出颈椎间盘均可较早发生长期、稳定的自然吸收现象,有利于提高远期治疗效果,这为脊髓型颈椎病的治疗提供了新的策略和依据。BACKGROUND:Previous studies have suggested that the resorption of herniated nucleus pulposus of herniated cervical intervertebral disc is related to the type and location of herniation.It is unclear whether the degree of degeneration of herniated cervical intervertebral disc will affect the occurrence of resorption of herniated nucleus pulposus phenomenon.OBJECTIVE:To observe the absorption of intervertebral discs with different degrees of degeneration after cervical microendoscopic laminoplasty,and analyze its characteristics and possible mechanism,providing a more reasonable strategy and basis for the treatment of cervical spondylotic myelopathy.METHODS:Retrospective study was conducted to analyze the general data and imaging data of 54 patients with cervical spondylotic myelopathy who underwent cervical microendoscopic laminoplasty from January 2014 to January 2020 in the First Affiliated Hospital of Zhengzhou University.Miyazaki grading criteria were used to evaluate the degree of cervical disc degeneration and grouping.Three-dimensional volume method was used to measure the volume of cervical herniated discs before operation and at the last follow-up.The absorption rate and absorption ratio were used to evaluate the occurrence of resorption of herniated nucleus pulposus.The Japanese Orthopaedic Association score was used to evaluate the clinical efficacy.RESULTS AND CONCLUSION:(1)All the 54 patients were followed up,including 29 males and 25 females,aged 54.81±9.76 years old.The course of disease was 10.54±8.48 months.The follow-up time was 10 days to 76 months.(2)A total of 159 cervical herniated discs were observed,of which 87.42%(139/159)were absorbed to varying degrees.(3)Due to the small number of gradesⅠandⅤ,they were not included in the statistical analysis.The absorption rate and absorption ratio of gradeⅡdegeneration group,gradeⅢdegeneration group and grade IV degeneration group were(40.60±25.72)%,(36.12±18.30)%,(37.49±27.95)%and 85.42%(41/48),89.23%(58/65),87.50%(35/40),respectively,an

关 键 词：脊髓型颈椎病 内镜 微创 颈椎管成形术 突出椎间盘吸收 颈椎间盘退变程度 Miyazaki分级标准 

分 类 号：R459.9[医药卫生—治疗学] R681.53[医药卫生—临床医学]