经椎板入路全内镜下椎间盘部分切除术治疗神经根型颈椎病的短期临床疗效分析  

Percutaneous endoscopic cervical discectomy with lamina-hole approach in treatment of cervical radiculopathy:an analysis of short-term clinical outcomes

作　　者：李申 曹珑耀 赵郭盛 程思[1] 杜宇[1] 冯志松[1] 向明玉 先林燕 邓忠良[1] 晏铮剑[1] LI Shen;CAO Longyao;ZHAO Guosheng;CHENG Si;DU Yu;FENG Zhisong;XIANG Mingyu;XIAN Linyan;DENG Zhongliang;YAN Zhengjian(Department of Orthopedics,the Second Affiliated Hospital of Chongqing Medical University,Chongqing,400010,China)

机构地区：[1]重庆医科大学附属第二医院骨科,重庆400010

出　　处：《陆军军医大学学报》2022年第2期175-181,共7页Journal of Army Medical University

基　　金：重庆市技术创新与应用发展专项重点项目(CSTC2019jscx-gksbX0027);重庆市技术创新与应用开发项目(2021MSXM004)。

摘　　要：目的探讨经椎板入路全内镜下椎间盘部分切除术治疗神经根型颈椎病的临床疗效。方法回顾性分析2018年5月至2019年12月本院骨科收治的30例采用经椎板入路全内镜下椎间盘部分切除术治疗神经根型颈椎病患者的临床资料。记录手术时间,术中出血量,术中相关并发症,术前、术后及末次随访时颈部功能障碍指数(neck disability index,NDI)评分,颈部视觉模拟(visual analog scale,VAS)评分及上肢VAS评分以进行疗效评估。结果患者均成功完成手术。手术时间30~200(84.5±36.5)min,术中出血量5~50(20.5±11.8)mL。术中及术后均未观察到神经血管损伤及其他严重并发症。患者随访时间为9~23(14.3±4.0)个月。NDI评分由术前(61.3±13.2)分降低至术后(26.6±7.4)分(P<0.01),末次随访时进一步降低至(9.8±3.5)分(P<0.01)。术前颈部及上肢VAS评分分别为(5.2±0.7)分和(6.5±1.1)分,术后分别降低至(3.1±0.7)分和(2.8±0.7)分(P<0.01),末次随访时进一步降低至(0.6±0.8)分和(0.5±0.6)分(P<0.01)。结论经椎板入路全内镜下椎间盘部分切除术可在保留关节突关节的同时完成神经根直接减压,缓解患者的神经根压迫症状,是神经根型颈椎病治疗的一种新选择。Objective To investigate the clinical outcomes of percutaneous endoscopic cervical discectomy with lamina-hole approach for cervical radiculopathy.Methods A retrospective case series study was conducted to analyze clinical data of 30 patients with cervical radiculopathy admitted in our department from May 2018 to December 2019.All patients underwent percutaneous endoscopic cervical discectomy with lamina-hole approach.The operative time,intraoperative blood loss,intraoperative complications were collected and analyzed.Neck disability index(NDI)and visual analogue scale(VAS)of neck and arm were used preoperatively,postoperatively and at the end of follow-up.Results All patients successfully completed the operation.Their operation time was 30~200(84.5±36.5)min,and the intraoperative blood loss was 5~50(20.5±11.8)mL.No neurovascular injury was observed intra-operatively and post-operatively.The follow-up time was 9~23(14.3±4.0)months.The NDI scores were decreased from 61.3±13.2 pre-operatively to 26.6±7.4 post-operatively(P<0.01),and further reduced to 9.8±3.5 at the last follow-up(P<0.01).The VAS scores of the neck and arm were 5.2±0.7 and 6.5±1.1 before operation,and decreased to 3.1±0.7 and 2.8±0.7(P<0.01)after operation,respectively.At the last follow-up,the values were further reduced to 0.6±0.8 and 0.5±0.6(P<0.01),respectively.Conclusion Percutaneous endoscopic cervical discectomy with lamina-hole approach is a new option for cervical radiculopathy,and can achieve the decompression of nerve root with preserving facet joint integrally.

关 键 词：颈椎病 神经根型 微创手术 内窥镜 椎间盘切除 

分 类 号：R681.55[医药卫生—骨科学] R687.3[医药卫生—外科学]