软质内镜下颈前路椎间盘切除融合术治疗单节段脊髓型颈椎病的早期临床疗效

Early clinical efficacy of anterior cervical discectomy and fusion under soft endoscopic minimally invasive system for single-level cervical spondylotic myelopathy

中文关键词:  软质内镜  脊髓型颈椎病  颈前路椎间盘切除融合术  脊柱微创技术

英文关键词:Soft endoscope  Cervical spondylotic myelopathy  Anterior cervical discectomy and fusion  Minimally invasive

中文摘要:

  【摘要】 目的：探讨软质内镜下颈前路椎间盘切除融合术（L-unitary soft endoscopic anterior cervical discectomy and fusion，LUSE-ACDF）治疗单节段脊髓型颈椎病（cervical spondylotic myelopathy，CSM）的有效性和安全性。方法：回顾性对照分析2022年8月~2023年11月在我院接受单节段颈前路椎间盘切除融合术（anterior cervical discectomy and fusion，ACDF）治疗的48例CSM患者的病历资料，其中24例采用LUSE-ACDF治疗，纳入LUSE-ACDF组，男性9例，女性15例，年龄57.83±10.51岁；24例采用传统ACDF治疗，纳入传统ACDF组，男性11例，女性13例，年龄54.33±14.78岁。两组患者的年龄、性别、身高、体重等基线资料无显著性差异（P＞0.05）。收集并比较两组患者的手术时间、手术切口长度、术中失血量、术后住院时长以及围手术期并发症发生情况。术前及术后1周、1个月、3个月和6个月随访时通过日本骨科协会评分（Japanese Orthopaedic Association，JOA）和颈肩部疼痛视觉模拟量表（visual analogue scale，VAS）评分评估临床疗效，并于术后6个月时通过CT/MRI测量评估融合率、C2-7矢状面Cobb角、手术节段前柱高度及椎管最小矢状径。结果：48例患者均成功完成手术，随访期内未观察到围手术期并发症发生。LUSE-ACDF组与传统ACDF组末次随访时JOA评分和VAS评分均较术前显著改善（P＜0.001），两组间末次随访时比较无统计学差异（P＞0.05）。LUSE-ACDF组在术后1周随访时VAS评分显著低于传统ACDF组（2.00±1.06分 vs 2.88±1.12分，P＜0.01），并且具有更小的手术切口（3.46±1.12cm vs 4.25±0.87cm，P＜0.01）。LUSE-ACDF组术后6个月时手术节段椎管最小矢状径（14.16±1.98mm vs 10.82±1.86mm，P＜0.001）及手术节段前柱高度（34.45±6.08mm vs 29.48±3.86mm，P＜0.05）较术前显著改善，而C2-7 Cobb角与术前测量值无显著差异（P＞0.05）；传统ACDF组此三项参数在手术前后无显著变化（P＞0.05）。LUSE-ACDF组术后6个月手术节段椎管最小矢状径改善显著优于传统ACDF组（14.16±1.98mm vs 11.92±1.68mm，P＜0.05），其余影像学参数测量值两组间同时间点比较无显著差异。术后MRI显示两组均未见明显的椎前软组织水肿。结论：LUSE-ACDF治疗单节段CSM临床疗效满意，且与ACDF疗效相当，LUSE-ACDF具有患者术后早期恢复更佳的优势。

英文摘要:

  【Abstract】 Objectives: To explore the efficacy and safety of a novel L-unitary soft endoscopic anterior cervical discectomy and fusion(LUSE-ACDF) technique in the treatment of single-level cervical spondylotic myelopathy(CSM). Methods: A retrospective controlled analysis was conducted on the medical records of 48 patients with CSM who underwent single-level anterior cervical discectomy and fusion(ACDF) between August 2022 and November 2023. Among the patients, 24 were treated with LUSE-ACDF and were included in the LUSE-ACDF group, comprising 9 males and 15 females, with a mean age of 57.83±10.51 years; The remaining 24 underwent conventional ACDF and were included in the conventional ACDF group, comprising 11 males and 13 females, with a mean age of 54.33±14.78 years. There were no significant differences between the two groups in terms of baseline characteristics such as age, gender, height and weight(P>0.05). Data on operative time, incision length, intraoperative blood loss, duration of hospital stay, and the incidence of perioperative complications were collected and compared between the two groups of patients. Preoperatively and at 1 week, 1 month, 3 months and 6 months post-operatively, clinical efficacy was assessed using the Japanese Orthopaedic Association(JOA) score and visual analogue scale(VAS) for neck and shoulder pain. At 6 months post-operatively, fusion rates, C2-7 sagittal Cobb angle, anterior column height and minimum sagittal diameter of the spinal canal of the operative segment were measured and evaluated using CT/MRI. Results: All surgeries were successful with no perioperative complications observed during the follow-up period of this study. At the final follow-up, both the JOA score and VAS score in the LUSE-ACDF group showed significant improvement compared with preoperative levels(P<0.001), while there was no statistically significant difference between the two groups(P>0.05). At 1 week postoperatively, the LUSE-ACDF group demonstrated significantly greater improvement in VAS scores compared with the conventional ACDF group(2.00±1.06 vs 2.88±1.12, P<0.01), and had a smaller surgical incision(3.46±1.12cm vs 4.25±0.87cm, P<0.01). At 6 months postoperatively, the LUSE-ACDF group demonstrated significant improvements in the minimum sagittal diameter of the spinal canal(14.16±1.98mm vs 10.82±1.86mm, P<0.001) and the anterior column height of the operative segment(34.45±6.08mm vs 29.48±3.86mm, P<0.05) compared with preoperative measurements, while there was no significant difference in the C2-7 Cobb angle compared with preoperative measurements(P>0.05). In the conventional ACDF group, there were no significant changes in these three parameters before or after surgery(P>0.05). At 6 months post-operatively, the improvement in the minimum sagittal diameter of the spinal canal was significantly greater in the LUSE-ACDF group than in the conventional ACDF group(14.16±1.98mm vs 11.92±1.68mm, P<0.05); however, there were no significant differences between the two groups in the measurements of the other radiological parameters at the same time point. Postoperative MRI revealed no significant prevertebral soft tissue edema in either group. Conclusions: LUSE-ACDF can yield favorable clinical results comparable to conventional ACDF in the treatment of single-level CSM, with specific benefits in early postoperative recovery.