可视化环锯减压在老年颈椎管狭窄症合并骨质疏松全脊柱内镜术中应用的效果观察  

Application of full-endoscopic trephination-based decompression in senile cervical spinal stenosis with osteoporosis

作　　者：卜晋辉 许龙 王振飞 夏梦娇 黄森 雷雁 何博 席健伟 董明会 陈涛 马超[3] 刘光旺[3] BU Jinhui;XU Long;WANG Zhenfei;XIA Mengjiao;HUANG Sen;LEI Yan;HE Bo;XI Jianwei;DONG Minghui;CHEN Tao;MA Chao;LIU Guangwang(Affiliated Xuzhou Clinical College of Xuzhou Medical University,Xuzhou,Jiangsu 221009,China;不详)

机构地区：[1]徐州医科大学徐州临床学院,江苏徐州221009 [2]蚌埠医学院,安徽蚌埠233030 [3]徐州市中心医院脊柱外科,江苏221009

出　　处：《中国骨与关节损伤杂志》2023年第7期673-677,共5页Chinese Journal of Bone and Joint Injury

基　　金：江苏省卫生健康委员会医学科研面上项目(M2022048);江苏省青年医学重点人才计划项目(QNRC2016392);徐州市医学领军人才培养项目(XWRCHT20210035);徐州市引进临床医学专家团队项目(2019TD002)。

摘　　要：目的评价可视化环锯减压在全脊柱内镜手术治疗老年颈椎管狭窄症合并骨质疏松中应用的可行性和安全性。方法回顾性分析自2019-06—2021-10诊治的15例单节段颈椎管狭窄症合并骨质疏松,在全脊柱内镜下用可视化环锯环钻进行椎板开窗减压,其他步骤包括穿刺定位、建立工作套管和神经腹侧减压操作按照常规技术完成。比较手术前后疼痛VAS评分、NDI指数、JOA评分、影像学参数。结果15例均获得随访,随访时间12~15个月,平均13.3个月。术后颈椎CT与MRI显示手术节段颈椎管减压充分,脊髓及神经根未受压。末次随访时疗效评定结果:优12例,良2例,可1例。术后第3天疼痛VAS评分、NDI指数、JOA评分较术前明显改善,差异有统计学意义(P<0.05);术后6个月、12个月上述观察指标较术后第3天进一步改善,差异有统计学意义(P<0.05);术后6个月与术后12个月比较上述观察指标差异无统计学意义(P>0.05)。末次随访时手术节段椎体间角度位移、椎体间水平位移、节段角度、颈椎曲度与术前比较差异无统计学意义(P>0.05)。结论采用全脊柱内镜手术治疗老年颈椎管狭窄症合并骨质疏松患者时,术中使用可视化环锯减压具有定位准确、创伤小、安全性高等优点,特别是对于患有骨质疏松且不能耐受传统开放手术的老年患者,这是一种安全有效的微创手术方式。Objective To evaluate the feasibility and safety of percutaneous full-endoscopic cervical decompression using a visualized trephine for senile cervical spinal stenosis combined with osteoporosis.Methods A retrospective analysis of 15 cases of single-segment cervical stenosis combined with osteoporosis treated from June 2019 to October 2021 was conducted.The patients underwent cervical lamina decompression procedure using a visualized trephine under full spine endoscopy,and other steps including puncture positioning,establishment of working cannula and decompression for ventral nerve were completed according to conventional techniques.The VAS score of pain,NDI index,JOA score and imaging parameters were compared before and after surgery.Results All 15 cases were followed up for an average of 13.3 months(12-15 months).Postoperative CT and MRI showed adequate decompression of the surgical segment cervical canal,and no compression of the spinal cord or nerve roots.The final follow-up evaluation showed excellent outcome in 12 cases,good in 2 cases,and fair in 1 case.The pain VAS score,NDI index,and JOA score significantly improved at 3 days after surgery compared to those before surgery(P<0.05),and these indices continued to improve further at 6 and 12 months after surgery(P<0.05).However,there was no significant difference in these indices between 6 and 12 months after surgery(P>0.05).There was no significant statistical difference in imaging parameters(angular displacement,horizontal displacement,segmental angulation,cervical curvature angulation)between before operation and at the final follow-up(P>0.05).Conclusion Percutaneous spine endoscopic decompression using a visualized trephine for senile cervical spinal stenosis combined with osteoporosis is associated with accurate positioning,small trauma and high safety,and can be a safe and effective surgical option for elderly patients who can not tolerate traditional open surgery with osteoporosis.

关 键 词：颈椎管狭窄症 骨质疏松 脊柱内镜 可视化环锯 老年 

分 类 号：R681.5[医药卫生—骨科学]