环锯在前路内镜颈椎经椎体减压的应用  

Trephine used in anterior endoscopic cervical transcorporeal discectomy

作　　者：杜迁 付智慧 曹广如 孔维军 辛志军 廖文波 DU Qian;FU Zhi-hui;CAO Guang-ru;KONG Wei-jun;XIN Zhi-jun;LIAO Wen-bo(Department of Orthopaedic Surgery,The Second Affiliated Hospital,Zunyi Medical University,Zu-nyi 563000,China;Department of Orthopaedic Surgery,Affiliated Hospital,Zunyi Medical University,Zunyi 563000,China)

机构地区：[1]遵义医科大学第二附属医院骨外科,贵州遵义563000 [2]遵义医科大学附属医院脊柱外科,贵州遵义563000

出　　处：《中国矫形外科杂志》2023年第15期1427-1430,共4页Orthopedic Journal of China

基　　金：贵州省卫生健康委科学技术基金项目(编号:gzwkj2021-253);国家自然科学基金地区科学基金项目(编号:82060415)。

摘　　要：[目的]探讨环锯在前路内镜颈椎经椎体减压术(anterior endoscopic cervical transcorporeal decompression, AECTcD)中的应用效果。[方法]回顾性分析2018年9月—2019年9月采用外径6.6 mm环锯钻孔行AECTcD治疗颈椎间盘突出症29例患者。观察临床及影像效果。[结果]所有患者手术均顺利完成,术中无食管、血管、神经损伤等严重并发症。手术时间平均(86.0±9.3)min,切口均I期愈合,住院时间平均(5.6±1.8)d。所有患者随访时间平均(29.2±3.7)个月,与术前相比,术后24个月VAS评分显著减少(P<0.05),JOA评分显著增加(P<0.05)。影像方面,与术前相比,术后24个月椎间盘高度较术前显著降低(P<0.05),椎管面积较术前显著增加(P<0.05),钻孔椎体高度较术前差异无统计学意义(P>0.05),末次随访骨通道已骨性愈合。[结论] AECTcD中环锯的应用加强了椎体骨通道建立的可控性,提高了骨通道建立的精准性。[Objective]To explore the clinical outcomes of trephine used in anterior endoscopic cervical transcorporeal discectomy(AECTcD)for cervical disc herniation.[Methods]From Sep.2018 to Sep.2019,29 patients received AECTcD with trephine used for creat⁃ing a bone tunnel for central cervical disc herniation(CDH)in our departments.The clinical and imaging consequences were evaluated.[Re⁃sults]All the patients had operation performed smoothly without injuries to blood vessel,nerves and esophagus,whereas with operation time of(86.0±9.3)min on an average,well incision healing and hospital stay of(5.6±1.8)days.The VAS score significantly decreased,while JOA score significantly increased at the latest follow-up lasted for(29.2±3.7)months on an average compared with those preoperatively(P<0.05).Radiographically,the intervertebral disc height decreased significantly(P<0.05),whereas the cross-section area of spinal canal increased significantly(P<0.05),and the involved vertebral body height remained unchanged(P<0.05)at the latest follow up compared with those pre⁃operatively.[Conclusion]The trephine used in AECTcD takes the advantages of higher controllability and accuracy for the establishment of bony channel.

关 键 词：颈椎间盘突出症 环锯 内镜 骨通道 颈椎间盘切除 

分 类 号：R687[医药卫生—骨科学]