单通道分体内镜治疗神经根型颈椎病的疗效  

Analysis of the curative effect of open spinal endoscopy treatment of cervical spondylotic radiculopathy

作　　者：刘鑫[1] 张强[2] 朱锴[1] 王建业 李岳飞 胡鹏[1] 窦永峰[1] 耿晓鹏[1] 孙兆忠[1] LIU Xin;ZHANG Qiang;ZHU Kai;WANG Jianye;LI Yuefei;HU Peng;DOU Yongfeng;GENG Xiaopeng;SUN Zhaozhong(Department of Spine Surgery,Binzhou Medical University Hospital,Binzhou 256603,Shandong,P.R.China;Department of Radiology,Binzhou Medical University Hospital,Binzhou 256603,Shandong,P.R.China)

机构地区：[1]滨州医学院附属医院脊柱外科,山东滨州256603 [2]滨州医学院附属医院放射科,山东滨州256603

出　　处：《滨州医学院学报》2023年第4期263-266,270,共5页Journal of Binzhou Medical University

基　　金：山东省自然科学基金(2R2017LH021);滨州医学院科技计划(BY2018KJ03)。

摘　　要：目的比较颈椎后路单通道分体内镜(OSE)与经皮颈椎后路内镜(PPECD)治疗神经根型颈椎病创伤反应、短期疗效,总结手术经验,为临床技术开展提供依据。方法回顾性分析42例单节段神经根型颈椎病(CSR)患者,术前完善颈椎正侧位、颈椎CT及颈椎MR,根据纳入、排除标准,筛选33例患者入组。15例患者行OSE技术,18例行PPECD技术,术前均于3D-CT根据关节突关节间隙最内侧端垂线与下关节突内下端交点(O点)测量开窗范围,术中镜下寻找“O”点,应用动力钻配合微型椎板咬骨钳开骨窗,实现椎管内减压。比较两者术后切口长度、出血量、手术时间及患侧术后骨窗最大横向距离及纵向距离,术前、术后C反应蛋白(CRP)、肌酸激酶(CK),术后VAS评分、JOA评分。结果33例患者术后均获6月随访。术后MR复查见33例患者减压位置准确。A、B两组在手术时间、出血量、磨削直径等方面,差异均无统计学意义。A、B两组切口长度、CRP、CK及两指标增长幅度比较,P<0.05。术后VAS评分、JOA评分较术前改善,A、B组间比较差异无统计学意义。两组患者均无硬脊膜损伤、无神经根损伤等严重并发症。结论PPECD及OSE治疗CSR均具有创伤小,疗效好,恢复快的优势,可根据患者病情灵活选择。两种术式依据3D-CT评估,O点定位、界定骨窗范围,可实现精准、安全、有效减压。Objective To compare the traumatic reaction and short-term efficacy of the treatment for cervical spondylotic radiculopathy by open spinal endoscopy(OSE)and percutaneous posterior endoscopic cervical discectomy(PPECD),to summarize the surgical experience,and provide a basis for the development of clinical techniques.Methods A retrospective analysis was performed on 42 patients with single-segment CSR.Preoperative cervical X-ray,cervical CT and cervical MR were completed.According to the inclusion and exclusion criteria,33 patients were selected and enrolled.OSE technique was performed in 15 patients and PPECD technique was performed in 18 patients.Before the operation,the grinding bone range was measured by 3D-CT according to the intersection point(O point)between the most medial vertical line of the facet joint space and the inner lower end of the inferior facet,the"O point"was found under the intraoperative microscope,and the spinal canal decompression was realized by grinding bone with a power drill and a mini-lamina bone biter.The incision length,blood loss,operation time,maximum lateral and longitudinal distance of bone window,preoperative and postoperative CRP,CK,postoperative VAS score and JOA score were compared between the two groups.Results All 33 patients were followed up for 6 months after the operation.Postoperative MR reexamination showed that the decompression position was accurate in 33 patients.There was no significant difference in operation time,blood loss and grinding diameter between groups A and B(P>0.05).There were significant differences in incision length,CRP,CK and the growth rate of the two indicators(P<0.05).VAS score and JOA score after the operation were improved compared with those before the operation,and there was no significant difference between groups A and B.There were no serious complications such as spinal dural injury and nerve root injury in the two groups(P>0.05).Conclusion PPECD and OSE have the advantages of less trauma,good curative effect and rapid recovery in the tre

关 键 词：神经根型颈椎病 经皮颈椎后路内镜技术 单通道分体内镜技术 疗效 

分 类 号：R687[医药卫生—骨科学]