后路经皮内镜与前路间盘切除植骨融合术治疗神经根型颈椎病  

Comparative analysis of clinical efficacy between posterior percutaneous endoscopic discectomy and anterior cervical discectomy and fusion in the treatment of cervical spondylotic radiculopathy

作　　者：唐晓东 王瑞博 吕柏康 张长江 闫鹏 TANG Xiao-dong;WANG Rui-bo;LYU Bai-kang;ZHANG Chang-jiang;YAN Peng(The Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou450000,Henan,China)

机构地区：[1]郑州大学第五附属医院,河南郑州450000

出　　处：《中国骨伤》2023年第2期174-180,共7页China Journal of Orthopaedics and Traumatology

基　　金：河南省医学科技攻关联合共建项目(编号:2018020254)。

摘　　要：目的:探讨后路经皮内镜髓核摘除术(posterior percutaneous endoscopic discectomy,PPECD)治疗神经根型颈椎病的临床疗效。方法:对2017年12月至2020年10月外科治疗的56例单节段神经根型颈椎病患者进行回顾性分析。56例患者根据手术方式分为观察组和对照组,观察组27例,男16例,女11例,年龄34~61(51.15±6.29)岁,C4,58例、C5,613例、C6,76例,行经皮内镜髓核摘除术;对照组29例,男19例,女10例,年龄40~65(53.24±5.31)岁,C4,510例、C5,614例、C6,75例,行颈椎间盘切除植骨融合术。比较两组患者的手术时间、术中出血量、卧床时间、住院时间;采用疼痛视觉模拟评分(visual analogue scale,VAS)及颈部残障功能指数(neck disability index,NDI)对临床症状进行评估,并分析两组并发症情况;观察术后影像学资料。结果:56例患者均获得2年以上随访,观察组随访时间24~42(30.48±4.91)个月,对照组随访时间25~47(32.76±4.53)个月。观察组的手术时间、术中出血量、卧床时间、住院时间较对照组明显减少(P<0.05),两组颈痛和上肢痛VAS、NDI末次随访均较术前明显改善(P<0.05);观察组术后1 d颈痛和上肢痛VAS较对照组更低(P<0.05),两组术后1、3个月及末次随访的颈痛和上肢痛VAS、NDI组间差异无统计学意义(P>0.05)。观察组1例患者三角肌力量术后减弱至4级,保守治疗12周后恢复正常;术后2年对照组出现1例邻椎病伴髓性症状,择期行人工椎间盘置换恢复良好;1例术后吞咽呛咳,1年后稍好转;两组并发症发生率差异无统计学意义(P>0.05)。结论:与前路间盘切除植骨融合术相比,后路经皮内镜髓核摘除术治疗神经根型颈椎病具有如下优势,如出血量更少,手术时间更短,术后可更早活动,可缩短住院日等优点,但患者的适用年龄范围及中远期的临床疗效仍有待进一步研究。Objective To explore the clinical efficacy of posterior percutaneous endoscopic discectomy(PPECD)in the treatment of cervical spondylotic radiculopathy.Methods A total of 56 patiens with single segment cervical spondylotic radiculopathy from December 2017 to October 2020,were randomly divided into observation group and control group.In observation group,there were 16 males and 11 females,including 8 cases of C4,5,13 cases of C5,6 and 6 cases of C6,7 performed posterior percutaneous endoscopic discectomy,aged from 34 to 61 years old with an average of(51.15±6.29)years old.In control group,there were 19 males and 10 females with single segment cervical spondylotic radiculopathy including 10 cases of C4,5,14 cases of C5,6 and 5 cases of C6,7 performed anterior cervical discectomy and fusion,aged from 40 to 65 years old with an average of(53.24±5.31)years old.The operative time,intraoperative blood loss,postoperative time of lying in bed and length of postoperative hospital stay were recorded.Visual analogue scale(VAS)and neck disability index(NDI)were used to evaluate the clinical efficacy.Cervical plain films or MRIs,CTs were taken for re-visiting patients.Results All patients were followed up more than 2 years.The observation group patients were followed up,the duration ranged from 24 to 42 months with an average of(30.48±4.91)months.The control group patients were followed up,the duration ranged from 25 to 47 months,with an average of(32.76±4.53)months.Compared with control group,operative time,intraoperative blood loss,postoperative time of lying in bed and length of postoperative hospital stay were decreased(P<0.05).Compared with pre-operation,VAS of neck and upper limb and NDI at the latest follow-up between two groups were significantly improved(P<0.05).Compared with control group,VAS of neck and upper limb at 1 day after operation in observation group were significantly reduced(P<0.05).There was no significant difference in VAS of neck and upper limb and NID at 1,3 months and the latest follow-up after o

关 键 词：神经根型颈椎病 外科手术 内窥镜 颈前路间盘切除植骨融合术 

分 类 号：R681.53[医药卫生—骨科学]