单通道软质内镜辅助下颈椎前路椎间盘切除减压融合术治疗三节段颈椎病的早期疗效评价

Early clinical efficacy of L-unitary soft endoscope assisted anterior cervical discectomy and fusion for 3-level cervical spondylosis

中文关键词:  颈椎病  颈椎前路椎间盘切除减压融合术  软质内镜  微创脊柱手术

英文关键词:Cervical spondylosis  Anterior cervical discectomy and fusion  Soft endoscope  Minimally invasive spine surgery

中文摘要:

  【摘要】 目的：探讨单通道软质内镜辅助下颈椎前路椎间盘切除减压融合术（L-unitary soft endoscope-anterior cervical discectomy and fusion，LUSE-ACDF）治疗三节段颈椎病的早期临床疗效与安全性。方法：回顾性分析2019年1月~2025年3月于我院接受三节段ACDF的53例颈椎病患者的病历资料，其中26例采用LUSE-ACDF治疗，纳入LUSE组，男性17例，女性9例，年龄62.8±12.7岁；27例采用传统ACDF，纳入传统组，男性11例，女性16例，年龄58.5±10.6岁。两组患者的年龄、性别和手术节段等基线资料无显著性差异（P>0.05）。统计并比较两组患者的手术时间、术中出血量、术后引流量、下地时间、术后住院时间以及并发症发生情况。于术前、术后3d及末次随访时进行疼痛视觉模拟量表（visual analogue scale，VAS）评分、日本骨科协会（Japanese Orthopaedic Association，JOA）评分、颈椎功能障碍指数（neck disability index，NDI）评定；在侧位X线片上测量两组患者术前及末次随访时手术节段椎体前缘高度、后缘高度、手术节段Cobb角及C2~C7 Cobb角。结果：所有患者均顺利完成手术。LUSE组术后引流量显著性低于传统组[25.0（5.0，51.0）mL vs 40.0（30.0，60.0）mL，P=0.024]。两组手术时间[104.0（86.0，133.5）min vs 115.0（95.0，120.0）min]、术中出血量[40.0（20.0，50.0）mL vs 45.0（20.0，50.0）mL]、术后下地时间[20.5（17.8，23.5）h vs 20.0（17.0，23.0）h]及术后住院时间[5.5（4.0，7.0）d vs 5.0（4.0，7.0）d]均无统计学差异（P＞0.05）。术后随访10.3±2.9个月，两组术后3d及末次随访时VAS评分、JOA评分和NDI均较术前显著性改善（P＜0.001），两组间同时间点比较均无统计学差异（P＞0.05）。两组术后手术节段椎体前缘高度、后缘高度、手术节段Cobb角及颈椎C2~C7 Cobb角均较术前显著性改善（P＜0.001），两组间同时间点比较均无统计学差异（P＞0.05）。传统组出现1例硬膜外血肿，急诊行血肿清除术后神经症状较术前改善；其余患者均未出现吞咽困难、神经损伤、脑脊液漏等并发症。结论：LUSE-ACDF技术治疗三节段颈椎病效果良好，是一种安全、有效的微创手术方法。

英文摘要:

  【Abstract】 Objectives: To investigate the early clinical efficacy and safety of L-unitary soft endoscope-anterior cervical discectomy and fusion(LUSE-ACDF) for the treatment of 3-level cervical spondylosis. Methods: The medical records of 53 patients with cervical spondylosis who underwent 3-level ACDF at our hospital between January 2019 and March 2025 were retrospectively analyzed. 26 patients treated with LUSE-ACDF were assigned to the LUSE group(17 males and 9 females, with an average age of 62.8±12.7 years), while 27 patients treated with conventional ACDF were assigned to the conventional group(11 males and 16 females, with an age of 58.5±10.6 years). There were no significant differences between the two groups in baseline characteristics, including age, gender, and operative segment(P>0.05). Perioperative parameters, including operative time, intraoperative blood loss, postoperative drainage volume, time to ambulation, postoperative length of hospital stay, and complications were compared between the two groups. Clinical efficacy was evaluated using the visual analogue scale(VAS), Japanese Orthopaedic Association(JOA) score, and neck disability index(NDI) at preoperation, postoperative 3d, and final follow-up visits. Radiographic parameters, including anterior and posterior vertebral body heights, surgical segment Cobb angle, and C2-C7 Cobb angle were measured preoperatively and at final follow-up on lateral cervical radiographs. Results: All the patients successfully completed the surgery, and were followed up for 10.3±2.9 months. The LUSE group showed significantly lower postoperative drainage volume than the conventional group[25.0(5.0, 51.0)mL vs 40.0(30.0, 60.0)mL, P=0.024]. There were no significant differences between the two groups in terms of operative time[104.0(86.0, 133.5)min vs 115.0(95.0, 120.0)min] , intraoperative blood loss[40.0(20.0, 50.0)mL vs 45.0(20.0, 50.0)mL], time to ambulation[20.5(17.8, 23.5)h vs 20.0(17.0, 23.0)h], or postoperative length of hospital stay[5.5(4.0, 7.0)d vs 5.0(4.0, 7.0)d](P>0.05). Both groups showed significant improvements in VAS, JOA, and NDI scores at postoperative 3d and final follow-up compared to baseline(P<0.001), with no significant differences between the two groups at the same time points(P>0.05). Both groups demonstrated significant improvements in anterior and posterior vertebral body heights, surgical segment Cobb angle, and C2-C7 Cobb angle(P<0.001) after operation, with no significant differences between the two groups at the same time points(P>0.05). The conventional group had one case of epidural hematoma, and after emergency evacuation, the neurological symptoms of the patient improved; No other complications such as dysphagia, nerve injury, or cerebrospinal fluid leakage were observed. Conclusions: The LUSE-ACDF demonstrates satisfactory clinical outcomes in treating 3-level cervical spondylosis, which is a safe and effective minimally invasive technique.