三种内镜手术技术治疗神经根型颈椎病的临床疗效比较

Comparison of clinical efficacies between three endoscopic surgeries in treating cervical spondylotic radiculopathy

中文关键词:  神经根型颈椎病  单轴脊柱内镜技术  单侧双通道脊柱内镜技术  杂交技术

英文关键词:Cervical spondylotic radiculopathy  Uniportal endoscopy  Unilateral biportal endoscopy  Hybrid technique

中文摘要:

  【摘要】 目的：提出基于单侧双通道内镜技术（unilateral biportal endoscopy，UBE）结合脊柱内镜双操作通道的杂交技术（hybrid technique，HT），对比分析HT、UBE与单轴全脊柱内镜技术（uniportal endoscopic surgery，UES）治疗神经根型颈椎病（cervical spondylotic radiculopathy，CSR）的临床疗效。方法：回顾性分析2019年9月～2021年8月在上海市第一人民医院采用UES、UBE或HT手术治疗的63例CSR患者的临床资料，其中21例采用UES手术治疗（UES组），男11例，女10例；年龄43.19±9.83岁；C4/5 7例，C5/6 10例，C6/7 4例。19例采用UBE手术治疗（UBE组），男8例，女11例；年龄45.05±10.73岁；C4/5 6例，C5/6 11例，C6/7 2例。23例采用HT手术治疗（HT组），男12例，女11例，年龄46.78±11.38岁；C4/5 9例，C5/6 11例，C6/7 3例。统计各组手术时间、术中出血系数及住院时间；在术前及术后3d的CT与MRI影像上观察减压范围及软组织反应带。术前及术后3d、3个月和6个月时采用视觉模拟（visual analogue scale，VAS）评分评估患者颈肩痛和上肢神经根性疼痛，采用颈椎功能障碍指数（neck disability index，NDI）评价颈椎功能；术后6个月时采用改良MacNab标准评估手术疗效。结果：三组患者均顺利完成手术，并完成6个月随访。UBE组与HT组的手术时间显著性少于UES组（UBE组58.95±5.40min，HT组63.57±8.05min，UES组72.33±9.13min）（P<0.05）。UBE组的出血系数与住院时间均明显高于UES组与HT组（UBE组为1.61±0.21、5.84±0.67d，UES组为1.11±0.16、4.62±0.65d，HT组为1.37±0.12、4.56±0.66d）（P<0.05）。UBE组与HT组术后3d软组织反应带均明显大于UES组（UBE组7.49±0.88cm2，HT组7.22±0.43cm2，UES组5.01±0.41cm2）（P<0.05）。三组术后3d、3个月和6个月的颈肩痛VAS评分、上肢痛VAS评分及NDI均较术前显著性降低（P<0.05）；UBE组和HT组术后3d的颈肩部VAS评分明显高于UES组（UBE组3.89±0.97，HT组3.83±0.72，UES组2.81±0.73）（P<0.05），上肢痛VAS评分和NDI三组间比较均无显著性差异（P>0.05）；术后3个月和6个月三组颈肩痛VAS评分、上肢痛VAS评分、NDI以及术后6个月时的改良Macnab优良率均无显著性差异（P>0.05）。结论：应用三种内镜技术治疗CSR均获得较满意的临床疗效，三种内镜技术各有优缺点，临床上可根据实际情况选择使用。

英文摘要:

  【Abstract】 Objectives: To propose a hybrid technique(HT) combining unilateral biportal endoscopy(UBE) and double working channel spinal endoscopy and to compare uniportal endoscopic surgery(UES), UBE and HT in the treatment of cervical spondylotic radiculopathy(CSR). Methods: The clinical data of 63 CSR patients treated in Shanghai General Hospital with either UES, UBE, or HT between September 2019 and August 2021 were analyzed retrospectively. Among the patients, 21 were treated with UES(UES group, 11 males and 10 females, aged 43.19±9.83 years) involving C4/5 in 7 cases, C5/6 in 10 cases, and C6/7 in 4 cases; 19 were treated with UBE(UBE group, 8 males and 11 females, aged 45.05±10.73 years) involving C4/5 in 6 cases, C5/6 in 11 cases, and C6/7 in 2 cases; 23 were treated with HT(HT group, 12 males and 11 females, aged 46.78±11.38 years) involving C4/5 in 9 cases, C5/6 in 11 cases, and C6/7 in 3 cases. The operative time, intraoperative bleeding coefficient, and length and cost of hospital stay were collected, and the decompression range and soft tissue reaction band were observed on CT and MRI before operation and on postoperative 3d. At preoperation, postoperative 3d, 3 and 6 months, visual analogue scale(VAS) was employed to evaluate the neck and shoulder pain and upper limb nerve root pain, neck disability index(NDI) was used to assess cervical function, and modified Macnab criteria were adopted to evaluate clinical efficacy at postoperative 6 months. Results: All the patients were followed up for 6 months. The operative time in UBE group(58.95±5.40min) and HT group(63.57±8.05min) were significantly shorter than the UES group(72.33±9.13min)(P<0.05). The intraoperative bleeding coefficient and length of hospital stay were significantly greater in the UBE group(1.61±0.21, 5.84±0.67d) than those in the UES group(1.11±0.16, 4.62±0.65d) and HT group(1.37±0.12, 4.56±0.66d)(P<0.05). On 3 days after surgery, the soft tissue reaction band was larger in the UBE(7.49±0.88cm2) and HT group(7.22±0.43cm2) than that in the UES group(5.01±0.41cm2). The postoperative VAS and NDI decreasd significantly compared with the preoperative ones respectively in all the three groups(P<0.05). The VAS for neck and shoulder pain was significantly higher in the UBE group(3.89±0.97) and HT group(3.83±0.72) than that in the UES group(2.81±0.73)(P<0.05). However, there were no significant differences in the VAS for arm pain or the NDI between the three groups(P>0.05). The neck and shoulder pain VAS, arm pain VAS, NDI at postoperative 3-month and 6-month, and excellent and good rate of modified Macnab criteria at postoperative 6-month did not differ statistically in all the three groups, respectively(P>0.05). Conclusions: The three kinds of endoscopic surgeries all can achieve satisfactory clinical efficacies in treating CSR. The three endoscopic surgeries have their own advantages and disadvantages, which can be selected according to the actual situation in clinic.