神经根型颈椎病内镜与开放减压融合的比较  

Unilateral biportal endoscopic decompression versus anterior cervical decompression and fusion for single-segment cervi⁃cal spondylotic radiculopathy

作　　者：张镇武 陈炯灰 陈永龙 姜成 王伟 杨志超 李俊 黄春明 黄东杰 李小川 ZHANG Zhen-wu;CHEN Jiong-hui;CHEN Yong-long;JIANG Cheng;WANG Wei;YANG Zhi-chao;LI Jun;HUANG Chun-ming;HUANG Dong-jie;LI Xiao-chuan(Gaozhou Hospital,Guangdong Medical University,Maoming 525200,Guang-dong,China)

机构地区：[1]广东医科大学附属高州医院,广东茂名525200

出　　处：《中国矫形外科杂志》2025年第5期385-391,共7页Orthopedic Journal of China

基　　金：广东省自然科学基金项目(编号:2024A1515013042);广东省医学科学技术研究基金项目(编号:B2023375;B2024310)。

摘　　要：[目的]比较单侧双通道脊柱内镜术(unilateral biportal endoscopy,UBE)与开放颈前路减压植骨融合术(anterior cer⁃vical decompression and fusion,ACDF)治疗单节段神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的临床疗效。[方法]回顾性分析2021年1月—2023年6月本科手术治疗单节段CSR的28例患者的临床资料。依据术前医患沟通结果,12例接受UBE,另外16例接受ACDF,比较两组围手术期资料、随访及影像学资料。[结果]两组患者均顺利完成手术,UBE组切口长度[(1.9±0.1)cm vs(5.5±0.6)cm,P<0.001]、术中失血量[(22.1±5.0)mL vs(35.9±12.6)mL,P<0.001]及住院天数[(6.3±1.8)d vs(9.3±3.1)d,P=0.003]均显著优于ACDF组,但前者术中透视次数显著多于后者[(5.3±0.8)次vs(3.4±0.8)次,P<0.001]。两组患者随访时间均超过12个月,两组恢复完全负重活动时间的差异无统计学意义(P>0.05)。与术前相比,两组患者术后3个月及末次随访时VAS、NDI、JOA评分均显著改善(P<0.05)。同一时间点,两组间的上述评分的差异均无统计学意义(P>0.05)。影像方面,末次随访时,UBE组的椎间孔面积[(67.0±3.2)mm^(2)vs(61.2±3.6)mm2,P<0.001]、颈椎前凸角[(20.4±0.9)°vs(17.7±1.5)°,P<0.001]均显著优于ACDF组,但前者的椎间隙高度明显不及后者[(5.4±0.6)mm vs(6.0±0.7)mm,P=0.025]。[结论]UBE在治疗单节段CSR上与ACDF疗效相当,但内镜手术组织损伤更少,且术后恢复更快。[Objective]To compare clinical consequences of unilateral biportal endoscopy(UBE)versus anterior cervical decompression and fusion(ACDF)in the treatment of single-level cervical spondylotic radiculopathy(CSR).[Methods]A retrospective research was performed on 28 patients who had single-segment CSR treated surgically from January 2021 to June 2023.According to the preoperative doctor-patient communication,12 patients received UBE,while other16 patients received ACDF.The perioperative,follow-up and imaging data of the two groups were compared.[Results]All patients in both groups had corresponding surgical procedures performed smoothly.The UBE group proved significantly superior to the ACDF group in terms of incision length[(1.9±0.1)cm vs(5.5±0.6)cm,P<0.001],intraoperative blood loss[(22.1±5.0)mL vs(35.9±12.6)mL,P<0.001]and hospital stay[(6.3±1.8)days vs(9.3±3.1)days,P=0.003],despite of that the former consumed significantly more intraoperative fluoroscopy times than the latter[(5.3±0.8)times vs(3.4±0.8)times,P<0.001].The follow-up period was lasted for more than 12 months,and there was no significant difference in time to regain full weight-bearing activities between the two groups(P>0.05).The VAS,NDI and JOA scores in both groups were significantly improved 3 months after surgery and at the last follow-up compared with those preoperatively(P<0.05),whereas which were not statistically significant between the two groups at any time points accordingly(P>0.05).Radiographically,the UBE group proved significantly better than the ACDF group in terms of foramen area[(67.0±3.2)mm^(2)vs(61.2±3.6)mm^(2),P<0.001]and the cervical lordotic angle[(20.4±0.9)°vs(17.7±1.5)°,P<0.001],whereas the former had significantly less intervertebral height than the latter at the latest follow-up[(5.4±0.6)mm vs(6.0±0.7)mm,P=0.025].[Conclusion]The UBE does achieve satisfactory clinical outcome comparable with the ACDF in the treatment of single-segment CSR.The former takes advantages of less tissue injury and faster postoperativ

关 键 词：神经根型颈椎病 单侧双通道脊柱内镜减压术 微创手术 颈椎前路减压融合术 

分 类 号：R681.55[医药卫生—骨科学]