单轴内镜下颈椎前路椎间盘切除融合术治疗合并椎间盘钙化突出的脊髓型颈椎病疗效分析

Clinical efficacy of uniaxial endoscopic anterior cervical discectomy and fusion via mini-open approach for cervical spondylotic myelopathy with calcified disc herniation

中文关键词:  脊髓型颈椎病  椎间盘钙化突出  颈椎前路椎间盘切除融合术  单轴内镜  显微镜  微创脊柱外科

英文关键词:Cervical spondylotic myelopathy  Calcified disc herniation  Anterior cervical discectomy and fusion  Full-endoscopic spine surgery  Microscope  Minimally invasive spine surgery

中文摘要:

  【摘要】 目的：探讨单轴内镜下颈椎前路椎间盘切除融合术（endoscopic anterior cervical discectomy and fusion，Endo-ACDF）治疗合并椎间盘钙化突出的脊髓型颈椎病的临床疗效。方法：回顾性分析2022年5月~2025年1月在广东省中医院骨伤科专科医院脊柱微创中心接受治疗的22例伴单节段或双节段颈椎间盘钙化突出的脊髓型颈椎病（cervical spondylotic myelopathy，CSM）患者，其中11例采用Endo-ACDF治疗，纳入Endo-ACDF组（男6例，女5例；年龄38~77岁）；11例采用显微镜下颈椎前路椎间盘切除融合术（microscopic anterior cervical discectomy and fusion，Micro-ACDF）治疗，纳入Micro-ACDF组（男4例，女7例；年龄38~69岁）。比较两组患者的手术相关指标（手术时间、术中出血量、隐性失血量、术后住院天数）、影像学指标（术前及术后1d、1个月椎前软组织肿胀程度，术前术后椎间隙高度差值、颈椎整体前凸角差值、手术节段前凸角差值、椎管面积变化值）及临床指标[术前及术后1d、3个月、6个月、末次随访时的疼痛视觉模拟量表（visual analog 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）]，术后6个月的Bridwell分级。结果：两组患者年龄、性别、钙化及手术节段等基线资料无显著性差异（P>0.05）。Endo-ACDF组术中出血量显著性少于Micro-ACDF组（16.36±6.74mL vs 24.55±5.22mL，P=0.005），隐性失血量显著性少于Micro-ACDF组（131.32±64.17mL vs 203.54±81.26mL，P=0.013）。两组手术时间、术后住院天数无显著性差异（P>0.05）。Endo-ACDF组术前术后椎管面积变化值显著性大于Micro-ACDF组（53.21±24.90mm2 vs 34.82±15.87mm2，P=0.048），两组术前及术后各时间点软组织肿胀程度、椎间隙高度差值、颈椎整体及手术节段前凸角差值均无显著性差异（P>0.05）。两组术前及术后各时间点VAS评分、JOA评分、NDI及各指标改善程度均无显著性差异（P>0.05），术后6个月Bridwell分级亦无显著性差异（P>0.05）。结论：Endo-ACDF与Micro-ACDF治疗合并椎间盘钙化突出的CSM均能取得满意的临床疗效及融合效果，Endo-ACDF在减少术中及术后隐形出血量、椎管减压效率方面更具优势。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical efficacy of uniaxial endoscopic anterior cervical discectomy and fusion(Endo-ACDF) in the treatment of cervical spondylotic myelopathy(CSM) complicated with calcified disc herniation. Methods: A retrospective analysis was conducted on 22 CSM patients with single-level or double-level calcified cervical disc herniation who received treatment at the Spinal Minimally Invasive Surgery Center from May 2022 to January 2025. Among them, 11 patients undergone Endo-ACDF were assigned to the Endo-ACDF group(6 males and 5 females, aged 38-77 years); Another 11 patients received microscopic anterior cervical discectomy and fusion(Micro-ACDF) were included in the Micro-ACDF group(4 males and 7 females, aged 38-69 years). Perioperative indicators(operation time, intraoperative blood loss, hidden blood loss, postoperative hospital stay), radiological parameters(preoperative, 1d postoperative and 1-month postoperative prevertebral soft tissue swelling, differences in intervertebral height, overall cervical lordotic angle and segmental lordotic angle of the operative level, as well as changes in spinal canal area before and after surgery), and clinical outcome indicators[visual analogue scale(VAS) score, Japanese Orthopaedic Association(JOA) score and neck disability index(NDI)] before operation, at 1d, 3 months, 6 months postoperatively and the final follow-up, along with Bridwell grading at 6 months after surgery were compared between the two groups. Results: There were no significant differences in baseline data including age, gender, calcification status and operative segments between the two groups(P>0.05). The Endo-ACDF group presented significantly less intraoperative blood loss(16.36±6.74mL vs 24.55±5.22mL, P=0.005) and hidden blood loss(131.32±64.17mL vs 203.54±81.26mL, P=0.013) than the Micro group. No significant differences were observed in operation time and postoperative hospital stay between the two groups(P>0.05). The changes of postoperative spinal canal area in the Endo-ACDF group was notably higher than that in the Micro-ACDF group(53.21±24.90mm2 vs 34.82±15.87mm2, P=0.048). No intergroup differences were found in prevertebral soft tissue swelling, changes of intervertebral height, overall cervical lordosis and segmental lordosis at each time point before and after surgery(P>0.05). In terms of clinical outcomes, the two groups showed comparable VAS, JOA and NDI scores as well as their improvement degrees at all follow-up time points, with no significant difference in Bridwell grading at 6 months postoperatively(P>0.05). Conclusions: Both Endo-ACDF and Micro-ACDF can achieve satisfactory clinical outcomes and fusion effects for CSM combined with calcified disc herniation. Endo-ACDF has unique advantages in reducing intraoperative and postoperative hidden blood loss and improving the efficiency of spinal canal decompression.