脊髓型颈椎病内镜下前路椎间盘切除融合术  

Endoscopic anterior discectomy and fusion for cervical spondylotic myelopathy

作　　者：钟绵森 钟远鸣[2] 黄保华[2] 唐福波[2] 胡江 许伟 曾平 ZHONG Mian-sen;ZHONG Yuan-ming;HUANG Bao-Hua;TANG Fu-bo;HU Jiang;XU Wei;ZENG Ping(Guangxi University of Traditional Chinese Medicine,Nanning 530023,China;The First Affiliated Hospital,Guangxi University of Traditional Chinese Medicine,Nanning 530023,China)

机构地区：[1]广西中医药大学,广西南宁530023 [2]广西中医药大学第一附属医院,广西南宁530023

出　　处：《中国矫形外科杂志》2024年第4期368-371,共4页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81760874,82260942);广西重点研发计划项目(编号:桂科AB20159018);广西青年基金课题项目(编号:Z20200484,GXZYA20220025);2019年研究生教育创新计划项目(编号:JGY2019108)。

摘　　要：[目的]介绍内镜辅助下前路颈椎间盘切除融合术(endoscopic anterior cervical discectomy and fusion,E-ACDF)的手术技术和初步临床结果。[方法]2021年1月—2023年2月,对15例脊髓型颈椎病患者行E-ACDF术。内镜下切除突入椎管内的椎间盘组织、椎体骨赘、后纵韧带,确定硬膜前方完全减压无压迫,硬膜搏动恢复,用撑开器械将椎间隙撑开,将融合器置入椎间隙,将颈椎前路钉板放置融合节段正前方并固定钢板。[结果]所有患者顺利完成手术,术中无严重并发症,均获随访6~12个月。与术前相比,末次随访时VAS评分[(4.7±0.2),(2.2±0.1),P<0.001]、NDI评分[(31.7±1.4),(11.3±0.7),P<0.001]、JOA评分[(5.1±0.2),(11.5±0.3),P<0.001]均显著改善。术后复查颈椎影像,颈椎内固定及椎间盘术后在位,硬脊膜及神经根减压彻底。[结论]E-ACDF治疗脊髓型颈椎病,具有清晰的可视化手术视野,是一种精准、安全可靠且能够实现充分减压的手术方式,短期疗效满意。[Objective]To present the surgical techniques and preliminary clinical results of endoscopic anterior cervical discectomy and fusion(E-ACDF).[Methods]E-ACDF was performed on 15 patients with cervical spondylotic myelopathy from January 2021 to February 2023.The intervertebral disc tissue,osteophyte on the vertebral body,and posterior longitudinal ligament protruding into the spinal canal were removed under endoscope,and the anterior dural space was confirmed to be completely decompressed without compression,and the dural beating was restored.As the intervertebral space was extended with a distractor,a fusion cage was implanted into the space,and then anterior cervical plate was placed directly in front of the fusion segment,and was fixed with screws.[Results]All patients were successfully operated without serious complications,and followed up for 6 to 12 months.Compared with those preoperatively,VAS score[(4.7±0.2),(2.2±0.1),P<0.001],NDI score[(31.7±1.4),(11.3±0.7),P<0.001],JOA score[(5.1±0.2),(11.5±0.3),P<0.001]significantly improved at the latest follow up.Postoperative cervical images revealed internal fixation implants in proper position,with completely decompressed dura and nerve roots.[Conclusion]E-ACDF takes advantage of clear visual surgical field for the treatment of cervical spondylotic myelopathy.It is an accurate,safe and reliable surgical method for full decompression,and achieve satisfactory outcome in short-term.

关 键 词：脊髓型颈椎病 脊柱内镜 前路颈椎间盘切除融合术 

分 类 号：R681.55[医药卫生—骨科学]