颈后路Delta大通道全内镜技术治疗脊髓型和神经根型颈椎病的疗效分析  

Full-endoscopic technique through posterior cervical Delta large portal for cervical spondylotic myelopa-thy and radiculopathy

作　　者：陆龙卫 徐佳隆 童培建[2] Lu Longwei;Xu Jialong;Tong Peijian(Orthopedics Department,Jiaxing Xiuzhou District People's Hospital(Xincheng Hospital,Xiuzhou District Jiaxing City),Jiaxing 314015,China;Orthopedics Department,Zhejiang Provincial Hospital of Chinese Medicine,Hangzhou 310006,China)

机构地区：[1]嘉兴市秀洲区人民医院(嘉兴市秀洲区新塍医院)骨科,嘉兴314015 [2]浙江省中医院骨伤科,杭州310006

出　　处：《中华创伤骨科杂志》2023年第1期82-87,共6页Chinese Journal of Orthopaedic Trauma

基　　金：嘉兴市科技计划项目(2022C002)。

摘　　要：目的探讨颈后路Delta大通道全内镜技术治疗脊髓型和神经根型颈椎病的疗效。方法回顾性分析2020年1月至2021年6月嘉兴市秀洲区人民医院(嘉兴市秀洲区新塍医院)骨科收治的15例脊髓型和神经根型颈椎病患者资料。其中男6例,女9例;年龄54~76岁,平均66.2岁;责任节段:C_(3,4)3例,C_(4,5)4例,C_(5,6)7例,C_(6,7)1例。均采用颈后路Delta大通道全内镜技术治疗。通过比较患者术前、术后1、3个月、末次随访时颈椎功能障碍指数(NDI)、日本骨科协会(JOA)评分,以及末次随访时的改良Mac-Nab评分评价疗效,通过比较患者术前、术后1、3个月、末次随访时C2-7 cobb角、手术节段关节活动度(ROM)评价其对颈椎曲度和节段稳定性的影响。结果本组患者均顺利完成手术,手术时间56~82 min(平均65.7 min),术中出血量10~30 mL(平均20.7 mL)。所有患者均未发生组织感染、椎管内感染、硬膜撕裂、神经根损伤、麻醉围术期相关并发症等。所有患者均获随访,时间6~18个月(平均10.8个月)。术后1、3个月、末次随访时NDI评分(18.54%±3.06%、14.96%±2.33%、12.89%±2.33%)均显著低于术前(34.19%±3.83%),术后3个月、末次随访时NDI评分均显著低于术后1个月,差异均有统计学意义(P<0.05);术后3个月与末次随访时NDI评分比较,差异无统计学意义(P>0.05)。术后1、3个月、末次随访时的颈椎JOA评分[(12.28±1.65)、(13.30±1.57)、(13.54±1.41)分]均显著高于术前[(9.25±1.49)分],差异有统计学意义(P<0.05);术后各时间点间比较,差异均无统计学意义(P>0.05)。术前、术后1、3个月、末次随访时C2-7 cobb角、手术节段ROM比较,差异均无统计学意义(P>0.05)。末次随访时采用改良MacNab评分评价疗效:优9例,良5例,可1例。结论Delta大通道全内镜技术治疗脊髓型和神经根型颈椎病疗效良好,具有创伤小、并发症少、术后恢复快等优势,且不会影响颈椎曲度和节段稳定性。Objective To investigate the clinical efficacy of full-endoscopic technique through the posterior cervical Delta large portal for the treatment of cervical spondylotic myelopathy and radiculopathy.Methods The clinical data were analyzed retrospectively of the 15 patients who had been treated for cervical spondylotic myelopathy or radiculopathy at Orthopedics Department,Jiaxing Xiuzhou District People's Hospital from January 2020 to June 2021.There were 6 males and 9 females,aged from 54 to 76 years(average,66.2 years).Responsible levels:3 cases of C3,4,4 cases of C4,5,7 cases of C5,6 and 1 case of C6,7.They were all treated by full-endoscopic technique through the posterior cervical Delta large portal.The therapeutic efficacy was assessed by comparing the neck disability indexes(NDI)and Japanese Orthopaedic Association(JOA)cervical scores at preoperation,1 and 3 months post-operation,and the last follow-up,and the modified MacNab scores at the last follow-up.The operative effects on cervical curvature and segmental stability were assessed by comparing the C2-7 cobb angles and operative ranges of motion(ROM)at preoperation,1 and 3 months postoperation,and the last follow-up.Results All cases completed their operation successfully.The operation time ranged from 56 to 82 min(average,65.7 min),and the intraoperative blood loss from 10 to 30 mL(average,20.7 mL).Tissue infection,intraspinal infection,dural tear,nerve root injury or perioperative anesthesia-related complications occurred in none of the patients.All patients were followed up for 6 to 18 months(average 10.8 months).The NDIs at 1 and 3 months post-operation,and the last follow-up(18.54%±3.06%,14.96%±2.33%,and 12.89%±2.33%)were significantly lower than that before operation(34.19%±3.83%),and those at 3 months postoperation and the last follow-up significantly lower than that at 1 month postoperation(P<0.05),but there was no significant difference between 3 months postoperation and the last follow-up in NDI(P>0.05).The JOA scores at 1 and 3 months postop

关 键 词：颈椎 椎板切除术 减压术 颈椎病 Delta大通道 全内镜 

分 类 号：R687.3[医药卫生—骨科学]