经皮颈后路椎间孔镜髓核摘除术与经前路椎间盘切除内固定术治疗神经根型颈椎病疗效比较  

Comparison of the clinical efficacy between PPECD and ACDF for cervical spondylotic radiculopathy in the early stage

作　　者：王勇卓 张亚宁[1] 张志敏[1] WANG Yong-zhuo;ZHANG Ya-ning;ZHANG Zhi-min(Department of Spine Surgery,Linfen People's Hospital,Linfen,Shanxi,041000,China)

机构地区：[1]临汾市人民医院脊柱外科,山西041000

出　　处：《中国骨与关节杂志》2022年第7期486-491,共6页Chinese Journal of Bone and Joint

摘　　要：目的比较经皮颈后路椎间孔镜髓核摘除术(posterior percutaneous full-endoscopic cervical discectomy,PPECD)与经前路椎间盘切除内固定术(anterior cervical discectomy and fusion,ACDF)治疗伴有骨性狭窄的神经根型颈椎病的早期疗效。方法纳入我院2017年11月至2020年12月收治的神经根型颈椎病患者22例,根据手术方式分为观察组(PPECD组,n=11)和对照组(ACDF组,n=11)。随访12~24个月,平均(13.3±2.0)个月,记录两组患者手术时间、术中出血量、术前及术后12个月时颈肩疼痛视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分、颈椎功能障碍指数(neck disable index,NDI)、病变节段椎间高度、颈椎生理曲度并进行比较。结果所有患者均手术成功,无术中意外发生。两组患者手术时间差异无统计学意义(P>0.05)。观察组术中出血量显著少于对照组[(7.45±2.54)ml vs.(55.72±15.98)ml](P<0.05)。观察组患者颈痛与上肢痛VAS评分、JOA评分和NDI评分术前分别为6.45±1.69、7.91±1.30、10.55±1.69和33.64±4.34;术后分别为1.09±0.94、0.12±0.40、16.73±1.42和6.82±1.47。对照组患者颈痛与上肢痛VAS评分、JOA评分和NDI评分术前分别为6.18±1.25、7.73±1.27、10.00±1.61和32.09±4.23;术后分别为2.00±0.77、0.64±0.50、14.91±1.38和8.00±0.89。两组患者术后上述评分均较术前明显改善,差异有统计学意义(P<0.05)。术后两组病变椎间高度未见明显变化(P>0.05)。观察组患者手术前后颈椎曲度差异无统计学意义(P>0.05);对照组患者颈椎曲度术前为(10.60±1.29)°,术后为(16.36+1.05)°,差异有统计学意义(P<0.05)。结论PPECD可有效改善伴有骨性狭窄的神经根型颈椎病患者的颈肩部疼痛及神经功能,手术效果明显,但不影响颈椎的生理曲度及病变椎间高度,是一种值得推荐的手术方式。Objective To investigate the differences of the clinical efficacy between posterior percutaneous full-endoscopic cervical discectomy(PPED)and anterior cervical discectomy and fusion(ACDF)for cervical spondylotic radiculopathy with bony stenosis in the early stage.Methods A series of 22 patients with cervical spondylotic radiculopathy treated in our hospital were admitted to our study.All were divided into observation group(PPECD group,n=11)and control group(ACDF group,n=11).All patients were followed up for 12-24 months(mean:13.3±2.0 months).Operation time and intraoperative bleeding were observed.Visual analogue scale(VAS),Japanese Orthopaedic Association(JOA)score,neck disable index(NDI),height of intervertebral disc and physiological curvature of cervical vertebrae pre-operation and 12 months post-poperation were compared.Results All operations were performed successfully and no accidents occurred during operation.There were no significant differences in the operation time between the two groups(P>0.05).The amount of intraoperative bleeding of PPECD group(7.45±2.54)ml was significantly less than that of the ACDF group(55.72±15.98)ml(P<0.05).Preoperative indexes of the PPECD group:VAS(neck pain and upper limb pain)(6.45±1.69),(7.91±1.30);JOA(10.55±1.69);NDI(33.64±4.34).Postoperative indexes of the PPECD group:VAS score(neck and upper limb pain)(1.09±0.94),(0.12±0.40);JOA(16.73±1.42);NDI(6.82±1.47).Preoperative indexes of the ACDF group:VAS(neck pain and upper limb pain)(6.18±1.25),(7.73±1.27);JOA(10.00±1.61);NDI(32.09±4.23).Postoperative indexes of the ACDF group:VAS(neck pain and upper limb pain)(2.00±0.77),(0.64±0.50);JOA(14.91±1.38);NDI(8.00±0.89).These scores above were significantly improved after operation in the two groups(P<0.05).There were no significant changes of intervertebral height between the two groups after operation(P>0.05).No significant differences in cervical curvature were noted in PPECD group before and after operation(P>0.05).Cervical curvature of the ACDF group increa

关 键 词：颈椎病 最小侵入性外科手术 椎间盘切除术 

分 类 号：R687.3[医药卫生—骨科学]