低温等离子髓核消融术微创治疗神经根型颈椎病的效果评价研究  

Research on efficacy evaluation of minimally invasive treatment of cervical spondylotic radiculopathy using percutaneous coblation nucleoplasty

作　　者：郭红生[1] 高刚 李青山[1] 贾天阳 张凯[1] GUO Hong-sheng;GAO Gang;LI Qing-shan;JIA Tian-yang;ZHANG Kai(Department of Spinal Surgery,Handan Central Hospital,Hebei Province,Handan 056001,China;Department of Orthopedics,People′s Hospital Affiliated to Shanxi Medical University,Taiyuan 030012,China)

机构地区：[1]河北省邯郸市中心医院脊柱外科,河北邯郸056001 [2]山西医科大学附属人民医院骨科,山西太原030012

出　　处：《河北医科大学学报》2025年第4期386-392,共7页Journal of Hebei Medical University

基　　金：河北省医学科学研究课题计划项目(20220572)。

摘　　要：目的对比观察经皮低温等离子颈椎髓核消融术(percutaneous coblation nucleoplasty,PCN)与药物及物理治疗方法对神经根型颈椎病的效果,为神经根型颈椎病的优化治疗提供临床依据。方法收集2019年12月—2022年12月河北省邯郸市中心医院脊柱外科收治的神经根型颈椎病患者176例,分为药物组51例、理疗组57例和PCN组68例,药物组应用甘露醇、地塞米松及神经妥乐平静脉滴注;理疗组应用颈椎牵引物理手段进行治疗;PCN组接受PCN治疗。药物组及理疗组的治疗疗程均为14 d,PCN组在“C”形臂透视定位下,行PCN治疗。分别于治疗前和治疗后1 d、2周、3个月、6个月比较3组视觉模拟疼痛评分(visual analogue scale,VAS)评分、颈部失能指数(neck disability index,NDI)、颈痛量表(Northwick Park Neek Pain Questionnaire,NPQ)评分及田中靖久颈椎病症状量表20分法(YT20分法)。治疗后3个月以改良Macnab分级标准评定3组的综合治疗效果。结果3组VAS评分、NDI评分、NPQ指数均呈逐渐降低趋势,YT20评分呈逐渐升高趋势,PCN组VAS评分、NDI评分、NPQ指数低于药物组及理疗组,YT20评分高于药物组及理疗组,组间、时点间、组间·时点间交互作用差异均有统计学意义(F_(组间)=5.790、72.607、21.753、21.416,F_(时点间)=753.315、2345.915、2549.043、755.616,F_(组间·时点间)=4.276、133.825、20.694、19.612,均P<0.05)。治疗后3个月,PCN组总有效率(92.65%)高于药物组(47.06%)及理疗组(54.39%),差异有统计学意义(P<0.05)。结论应用PCN治疗神经根型颈椎病临床效果满意,患者的颈痛、上肢疼痛、麻木症状以及日常工作、生活质量均得到了极大的改善,颈椎功能良好,具有临床推广价值。Objective To comparatively evaluate the clinical effectiveness of percutaneous coblation nucleoplasty(PCN)versus medication and physical therapy for cervical spondylotic radiculopathy(CSR),so as to provide clinical evidence to optimize treatment strategies.Methods A total of 176 patients diagnosed with CSR from December 2019 to December 2022 in Department of Spinal Surgery,Handan Central Hospital,Hebei Province,were retrospectively analyzed and divided into three groups:medication group(n=51),physical therapy group(n=57),and PCN group(n=68).The medication group received intravenous mannitol,dexamethasone,and neurotropin for 14 d,the physical therapy group underwent cervical traction for 14 d,and the PCN group underwent PCN.The course of treatment for medication group and physical therapy group was 14 d,and PCN group received PCN guided by C-arm fluoroscopy.Visual analogue scale(VAS)score,neck disability index(NDI),Northwick Park Neck Pain Questionnaire(NPQ),and Yasuhisa Tanaka 20 score scale(YT20)scores were recorded before treatment and at 1 d,2 weeks,3 months,and 6 months after treatment.The modified Macnab criteria were used to assess overall therapeutic effectiveness at 3 months after treatment.Results All the three groups showed significant improvement in VAS,NDI,and NPQ scores(decreasing trends),and YT20 scores(increasing trends)over time.The PCN group exhibited superior outcomes compared with the medication and physical therapy groups,demonstrated by significantly lower VAS,NDI,and NPQ scores and higher YT20 scores.Significant differences were observed in the interaction between groups,time points,and time points between groups(F _(between groups)=5.790,72.607,21.753,21.416;F _(time points)=753.315,2345.915,2549.043,755.616;F_( time points between groups)=4.276,133.825,20.694,19.612;all P<0.05).At 3 months after treatment,the PCN group achieved a higher overall response rate(92.65%)compared with the medication group(47.06%)and physical therapy group(54.39%),showing significant differences(P<0.05).Conclusio

关 键 词：颈椎病 低温等离子髓核消融术 治疗结果 

分 类 号：R735.7[医药卫生—肿瘤]