软质内镜颈椎微创系统辅助前路椎间盘切除融合术治疗双节段脊髓型颈椎病  

The early clinical outcome of ACDF under a cervical soft endoscopic minimally invasive system in the treatment of two-segment cervical myelopathy

作　　者：赵庆豪 柳渊瀚 林荣振 郑志扬 刘则征 周欣莹 范超会 黎庆初 Zhao Qinghao;Liu Yuanhan;Lin Rongzhen;Zheng Zhiyang;Liu Zezheng;Zhou Xinying;Fan Chaohui;Li Qingchu(Department of Spine Surgery,the Third Affiliated Hospital of Southern Medical University,Guangzhou 510630,China)

机构地区：[1]南方医科大学第三附属医院脊柱外科,广州510630

出　　处：《中华骨科杂志》2025年第1期37-43,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨软质内镜颈椎微创系统辅助颈椎前路椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)治疗双节段脊髓型颈椎病的早期临床疗效。方法回顾性分析2022年10月至2023年12月在南方医科大学第三附属医院采用软质内镜颈椎微创系统辅助ACDF治疗23例双节段脊髓型颈椎病患者的病历资料,男15例、女8例,年龄(58.52±11.77)岁(范围37~79岁)。病变节段:C_(3)~C_(5)节段2例、C_(3),4和C_(5),6节段3例、C_(4)~C_(6)节段10例、C_(5)~C_(7)节段7例、C_(4),5和C_(6,7)节段1例。记录切口长度、术中出血量、手术时间及术后并发症发生情况,评估椎前软组织水肿发生率。术前、术后1周、术后1及3个月采用日本骨科协会(Japanese Orthopaedic Association,JOA)评分和颈肩部疼痛视觉模拟评分(visual analogue scale,VAS)评估临床疗效有,计算术后3个月JOA评分改善率。结果23例患者均顺利完成手术,手术时间为(80.09±22.66)min(范围53~127 min),切口长度为(3.25±0.32)cm(范围3~4 cm),估计术中出血量为(34.78±24.1)ml(范围10~100 ml),术后引流量为(23.13±26.32)ml(范围0~80 ml),术后住院时间为(6.83±2.59)d(范围4~12 d)。随访时间为(4.01±0.98)个月(范围3~6个月)。术后1周、术后1及3个月时JOA评分分别为12.00(11.00,14.00)分、13.00(12.00,14.00)分、15.00(15.00,16.00)分,较术前9.00(8.00,10.00)分均有改善(χ^(2)=220.492,P<0.001);术后1周、术后1及3个月时颈肩部疼痛VAS评分分别为3.00(2.00,3.00)分、2.00(2.00,3.00)分、2.00(1.00,2.00)分,较术前5.00(4.00,6.00)分均有改善(χ^(2)=170.869,P<0.001)。围手术期及随访期间无吞咽困难、声音嘶哑、神经损伤、脑脊液漏、椎管内血肿等并发症发生。术后影像学检查未发现明显椎前软组织水肿。术后3个月根据JOA评分改善率评定综合疗效,优14例、良9例。结论软质内镜颈椎微创系统辅助ACDF治疗双节段脊髓型颈椎病可以获得满意的早期疗效,常见�Objective To investigate the early clinical outcomes of anterior cervical discectomy and fusion(ACDF)in the treatment of two-segment cervical spondylotic myelopathy(CSM)using a cervical soft endoscopic minimally invasive system.Methods A retrospective follow-up study was conducted on the medical records of 23 patients with two-segment cervical myelopathy who underwent ACDF using a soft endoscopic cervical spine minimally invasive system at the Third Affiliated Hospital of Southern Medical University between October 2022 and December 2023.The cohort included 15 males and 8 females,aged 37-79 years(58.52±11.77 years).The affected cervical segments included:C_(3),4 and C_(4),5 in 2 cases;C_(3),4 and C_(5),6 in 3 cases;C_(4),5 and C_(5),6 in 10 cases;C_(5),6 and C_(6,7)in 7 cases;and C_(4),5 and C_(6,7)in 1 case.Clinical outcomes were evaluated based on the Japanese Orthopaedic Association(JOA)scores and visual analog scale(VAS)for neck and shoulder pain,assessed preoperatively and at 1 week,1 month,and 3 months postoperatively.Additional data recorded included incision length,intraoperative blood loss,operative time,postoperative complications,and the presence of prevertebral soft tissue edema.The improvement rate of JOA scores at the final follow-up was also calculated.Results All patients successfully underwent surgery and completed follow-up,with follow-up durations ranging from 3 to 6 months(4.01±0.98 months).The mean operative time was 80.09±22.66 min(range:53-127 min),and the mean incision length was 3.25±0.32 cm(range:3-4 cm).Estimated blood loss ranged from 10 to 100 ml,with a mean of 34.78±24.1 ml.Postoperative drainage ranged from 0 to 80 ml(mean:23.13±26.1 ml),and postoperative hospitalization durations ranged from 4 to 12 days(6.83±2.59 days).JOA scores improved significantly from a preoperative median of 9.00(8.00,10.00)to 12.00(11.00,14.00)at 1 week,13.00(12.00,14.00)at 1 month,and 15.00(15.00,16.00)at 3 months postoperatively(χ^(2)=220.492,P<0.001).VAS scores for neck and shoulder pain also im

关 键 词：颈椎病 椎间盘切除术 脊柱融合术 内窥镜检查 软质内镜 

分 类 号：R687.3[医药卫生—骨科学]