经皮通道下脊神经根显微减压术治疗神经根型颈椎病的临床研究  

Treatment of cervical spondylotic radiculopathy with spinal nerve root decompression under microscope and percutaneous tubular retractor system

作　　者：魏梁锋 陈业煌 薛亮 吴箭午 王守森 郑兆聪 Wei Liangfeng;Chen Yehuang;Xue Liang;Wu Jianwu;Wang Shousen;Zheng Zhaocong(Hospital of PLA Joint Logistics Team,Fuzhou 350025,China)

机构地区：[1]解放军联勤保障部队第九〇〇医院神经外科,福州350025

出　　处：《中华神经医学杂志》2023年第4期382-387,共6页Chinese Journal of Neuromedicine

基　　金：福建省自然科学基金(2021J011276);联勤保障部队第九〇〇医院院内课题(2020L18)。

摘　　要：目的探讨经皮通道下颈椎后路脊神经根显微减压术治疗神经根型颈椎病(CSR)的疗效。方法连续收集联勤保障部队第九〇〇医院神经外科自2019年9月至2022年10月收治的38例CSR患者,所有患者均经严格保守治疗无效后改行显微镜和经皮通道系统联合应用下颈椎后路脊神经根减压术治疗。38例患者随访(15.71±7.50)个月,范围为3~36个月。记录术前1 d、出院前、末次随访时疼痛视觉模拟评分(VAS)及颈椎病日本骨科协会(JOA)评分,以及该3个时间点的颈椎X线、CT、MRI复查结果。测量并比较术前及术后末次随访时CT重建影像上C_(2~7)矢状位垂直距离(SVA)值。根据公式改善率(%)=[(末次JOA-术前JOA)/(17-术前JOA)]×100%确定患者临床疗效,其中改善率100%定义为治愈,改善率>60%定义为显效,改善率为25%~60%定义为有效,改善率<25%定义为无效。结果38例患者术前VAS评分、JOA评分分别为(5.91±0.90)分、(11.37±1.50)分,末次随访时分别为(0.37±0.31)分、(15.76±1.44)分,差异均有统计学意义(P<0.05)。38例患者中治愈12例(31.6%),显效18例(47.4%),有效7例(18.4%),无效1例(2.6%);总有效率为97.4%。术中均未出现硬膜囊撕裂及明显神经损伤,术后均无术区感染。末次随访时C_(2~7)SVA为(15.82±0.95)mm,显著低于术前的(17.07±1.07)mm,差异有统计学意义(P<0.05)。结论颈椎后路背神经根显微减压术治疗单节段CSR疗效满意且安全性高;联合应用显微镜和通道系统可有效保证颈椎稳定性,保留相应运动节段。Objective To investigate the efficacy of posterior cervical spinal nerve root decompression under microscope and percutaneous tubular retractor system in cervical spondylotic radiculopathy(CSR).Methods A total of 38 patients with CSR,admitted to Department of Neurosurgery,900th Hospital of PLA Joint Logistics Team from September 2019 to October 2022 were enrolled consecutively.These patients failed in strict conservative treatment and then changed to posterior cervical spinal nerve root decompression under microscope and percutaneous tubular retractor system.The patients were followed up for(15.71±7.50)months,ranging from 3 to 36 months.The pain visual analogue scale(VAS)and Japanese Orthopedic Association(JOA)scores were recorded and the results of X-ray,CT and MRI of cervical spines were analyzed 1 d before decompression,before discharge and at the last follow-up.C_(2-7) sagittal vertical axis(SVA)was measured and compared on CT reconstruction images before decompression and at the last follow-up.The clinical efficacy of these patients was determined according to the formula of improvement rate=([JOA at the last follow-up-preoperative JOA]/[17-preoperative JOA])×100%:100%improvement rate was defined as cure,improvement rate>60%as significant effect,25%<improvement rate≤60%as valid treatment,and improvement rate≤25%was defined as invalid treatment.Results The VAS and JOA scores were 5.91±0.90 and 11.37±1.50 before decompression,and 0.37±0.31 and 15.76±1.44 at the last follow-up,respectively,with significant differences(P<0.05).Among 38 patients,12 patients(31.6%)were cured,18(47.4%)were significantly effective,7(18.4%)were valid,and 1(2.6%)was invalid,enjoying a total effective rate of 97.4%.Neither dural sac tear or obvious nerve injury during decompression nor infection after decompression were noted.The C_(2-7) SVA at the last follow-up([15.82±0.95]mm)was significantly lower than preoperative C_(2-7) SVA([17.07±1.07]mm,P<0.05).Conclusion Posterior cervical nerve root decompression can obtain satis

关 键 词：颈椎病 疼痛 神经根 显微外科手术 矢状面平衡 

分 类 号：R687.3[医药卫生—骨科学]