选择性神经阻滞联合经皮后路内镜颈椎间盘切除术治疗神经根型颈椎病的临床疗效观察  

Clinical observation of selective nerve block combined with percutaneous posterior endoscopic cervical discectomy in the treatment of cervical spondylotic radiculopathy

作　　者：吴昌兵 魏亚 马维邦 林博颖 代云磊 卢乾威 沈茂 WU Changbing;WEI Ya;MA Weibang;LIN Boying;DAI Yunlei;LU Qianwei;SHEN Mao(Clinical College of Guizhou Medical University,Guiyang 550004;Department of Orthopedics,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China)

机构地区：[1]贵州医科大学临床医学院,贵州贵阳550004 [2]贵州医科大学附属医院骨科,贵州贵阳550004

出　　处：《西安交通大学学报（医学版）》2022年第1期43-50,共8页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：贵州省科技计划项目(黔科合基础-ZK[2021]一般395)。

摘　　要：目的观察选择性神经阻滞联合经皮后路内镜下颈椎间盘切除术(PPECD)治疗神经根型颈椎病的近期临床疗效。方法回顾分析2018年6月至2020年1月共22例接受PPECD治疗神经根型颈椎病患者的数据。记录术前1 d及术后1 d、1个月、3个月、6个月、1年的日本骨科协会评估治疗评分(JOA)、疼痛视觉模拟评分(VAS)、颈部残疾指数评分(neck disability index scores,NDI),所有数据导入SPSS 26.0软件进行分析处理。定量数据表示为均值±标准差。采用重复测量方差分析比较不同时间点颈部VAS、手臂VAS、JOA和NDI评分。采用配对t检验比较术后各时间点各类评分和手术前第1天评分。P<0.05被认为差异具有统计学意义,最后一次随访时采用改良后的MacNab标准记录以评估临床效果。结果所有手术均在超声引导下选择性神经阻滞联合内镜操作下成功完成。总手术平均时间为125.6 min。术中失血量为2~100 mL,平均出血量为19.1 mL。所有患者均接受随访,时间为15~33个月,平均为24.1个月。患者均未出现脊髓、神经根、血管损伤、硬膜撕裂或其他并发症。术后各时间段VAS评分与术前VAS评分相比,颈部、上臂VAS评分均明显降低(P<0.05),而术后JOA评分明显提高(P<0.05),术前NDI评分与术前评分相比明显降低(P<0.05)。在最后一次随访中,改良后的MacNab标准显示15例优、5例良、2例中、0例差,优良率为91%。术后磁共振成像和颈椎三维计算机断层扫描重建表明,椎间盘被充分切除,手术节段神经根受压解除。结论对于诊断不明确的患者,诊断性SNRB可能是确定颈神经根性疼痛来源的有利的方法。在SNRB的指导下,PPECD是治疗诊断颈神经根病的有效和安全的选择,近期疗效可靠。Objective To observe the short-term clinical effect of selective nerve block combined with percutaneous posterior endoscopic cervical discectomy(PPECD)in the treatment of cervical spondylotic radiculopathy.Methods We reviewed 22 patients who received selective nerve block combined with percutaneous posterior endoscopic cervical discectomy(PPECD)for cervical spondylotic radiculopathy from June 2018 to January 2020.We recorded Japanese Orthopaedic Association(JOA)score for treatment evaluation,visual analogue scale(VAS),the neck disability index score(NDI)preoperative 1 day,postoperative 1 day,1 month,3 months,6 months and 1 year.All data were imported into SPSS26.0 software for analysis and processing.Quantitative data are expressed as mean±standard deviation.The scores of neck VAS,arm VAS,JOA and NDI were compared at different time points by repeated measurement analysis of variance.Paired t-test was used to compare each time point after operation and the first day before operation.P<0.05 was considered statistically significant,and the modified MacNab standard was used to evaluate the clinical effect at the last follow-up.Results All operations were successfully completed under ultrasound-guided selective nerve block combined with endoscopic operation.The average operation time was 125.6 minutes.The intraoperative blood loss was 2−100 mL and the average blood loss was 19.1 mL.All patients were followed up for 15−33 months,with an average follow-up of 24.1 months.No patients had spinal cord,nerve root and vascular injury,dural tear or other complications.Compared with the preoperative VAS score,the VAS score of neck and upper arm decreased significantly(P<0.05),while the JOA score increased significantly(P<0.05),and the preoperative NDI score decreased significantly(P<0.05).At the last follow-up,the modified Macnab criteria showed there were 15 excellent cases,5 good cases,2 medium cases and 0 poor case.The excellence rate was 91%.Postoperative magnetic resonance imaging and 3D computed tomography reconstruc

关 键 词：选择性神经根阻滞 经皮内镜颈椎间盘切除术 神经根型颈椎病 

分 类 号：R616.2[医药卫生—外科学]