单侧双通道内镜下颈椎间盘切除术治疗神经根型颈椎病  

Unilateral biportal endoscopic posterior cervical foraminotomy for cervical radiculopathy

作　　者：程伟 张宇俊 邵荣学[1] 朱承跃 王栋[1] 梁家铭 张伟[1] 潘浩[1] CHENG Wei;ZHANG Yu-jun;SHAO Rong-xue;ZHU Cheng-yue;WANG Dong;LIANG Jia-ming;ZHANG Wei;PAN Hao(Hangzhou TCM Hospital of Zhejiang Traditional Chinese Medical University,Hangzhou 310007,Zhejiang,China)

机构地区：[1]浙江中医药大学附属杭州市中医院,浙江杭州310007

出　　处：《中国骨伤》2024年第11期1046-1050,共5页China Journal of Orthopaedics and Traumatology

基　　金：浙江省医药卫生科技计划项目(编号:2022KY997,2022KY999)。

摘　　要：目的:探讨全身麻醉下后路单侧双通道内镜下颈椎间盘切除术治疗神经根型颈椎病的临床疗效。方法:回顾性分析2021年3月至2023年3月采用全身麻醉下后路单侧双通道内镜下颈椎间盘切除术治疗颈椎间盘突出症患者35例,男17例,女18例;年龄42~69(56.00±7.79)岁。非手术治疗时间6~27(16.03±4.56)周。MRI示外侧型颈椎间盘突出19例,椎间孔型颈椎间盘突出8例。病变节段:C4,55例,C5,612例,C6,718例。术后1~3 d复查颈椎CT/MRI评估减压情况,记录患者手术前后的颈肩部及上肢疼痛视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese Orthopedic Association,JOA)评分、颈椎手术节段的稳定性和椎间高度的变化。结果:35例均顺利完成手术,手术时间(55.88±5.02)min;术后住院时间(3.53±0.74)d;35例均获随访,时间12~24(14.53±2.32)个月。术前、术后1d及12个月VAS分别为(7.000±0.875)、(2.540±0.611)和(2.143±0.772)分,各时间点比较,差异有统计学意义(P<0.05);术前及术后1d、12个月JOA评分分别为(11.660±0.533)、(16.430±0.655)和(16.540±0.611)分,各时间点比较,差异有统计学意义(P<0.05);术前及术后12个月病变节段椎间高度分别为(6.206±0.493)和(6.147±0.497)mm,差异无统计学意义(P>0.05);术前及术后无颈椎手术节段不稳定发生。根据改良MacNab标准,术后12个月时对临床疗效进行评价,优32例,良2例,可1例。结论:全身麻醉下后路单侧双通道内镜下颈椎间盘切除术治疗单节段颈椎间盘突出症是一种微创、安全、有效的手术方式,可能是治疗颈椎椎间孔突出症的一种替代术式,但因样本量较少、随访时间短,其远期疗效有待进一步观察。Objective To investigate the clinical efficacy of posterior unilateral biportal endoscopic(UBE)cervical discectomy for cervical radiculopathy under general anesthesia.Methods A retrospective analysis of 35 patients with cervical disc herniation uderwent posterior UBE cervical discectomy under general anesthesia from March 2021 to March 2023 was performed,including 17 males and 18 females,with an average age of(56.00±7.79)years old ranging from 42 to 69 years old.The non-operative treatment time was 6 to 27 weeks with an average of(16.03±4.56)weeks.MRI showed lateral cervical disc herniation in 19 cases and foraminal cervical disc herniation in 8 cases.The pathological segments distribution was as follows L4,5 in 5 cases,C5,6 in 12 cases C6,7 in 18 cases.CT/MRI was performed 1 to 3 d after surgery to evaluate the decompression,and the visual analogue scale(VAS),the Japanese Orthopedic Association(JOA)score,the stability of cervical spine surgery segment and the change of intervertebral height were recorded.Results All 35 patients successfully completed the operation,and the operation time was(55.88±5.02)min,the hospital stay after surgery(3.53±0.74)d.All 35 patients were followed up from 12 to 24 months with an average of(14.53±2.32)months.The VAS of preoperative,postoperative 1 day and 12 months were(7.000±0.875),(2.540±0.611),(2.143±0.772),respectively,the VAS at each time point before and after surgery were statistically significant(P<0.05).The JOA scores of preoperative,postoperative 1 day and 12 months were(11.660±0.533),(16.430±0.655),(16.540±0.611),respectively.The intervertebral height of the lesion segment at preoperative and 12 months was(6.206±0.493)mm and(6.147±0.497)mmm,respectively,and the difference was not statistically significant(P>0.05).None of the patients had cervical spine segment instability before or after surgery.According to the modified Macnab criteria,the clinical efficacy was evaluated at 12 months after operation,32 cases were excellent,2 cases were good,and 1 case was go

关 键 词：单侧双通道内镜技术 椎间孔镜 后路髓核摘除术 钥匙孔 

分 类 号：R681.5[医药卫生—骨科学]