内镜与非内镜下颈前路椎间盘切除融合术治疗神经根型颈椎病的疗效比较

Comparison of the efficacy of endoscopic and non-endoscopic anterior cervical discectomy and fusion in the treatment of cervical spondylotic radiculopathy

中文关键词:  神经根型颈椎病  颈前路椎间盘切除融合术  内镜  微创手术

英文关键词:Cervical spondylotic radiculopathy  Anterior cervical discectomy and fusion  Endoscope-assisted  Minimally invasive surgery

中文摘要:

  【摘要】 目的：比较内镜下颈前路椎间盘切除融合术（endoscopic anterior cervical discectomy and fusion，Endo-ACDF）与传统开放颈前路椎间盘切除融合术（anterior cervical discectomy and fusion，ACDF）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2022年1月~2024年6月在我院手术治疗的67例CSR患者的临床资料，其中32例采用Endo-ACDF治疗，纳入Endo-ACDF组（男18例，女14例；年龄47.6±8.3岁）；35例采用ACDF治疗，纳入ACDF组（男20例，女15例；年龄48.4±8.7岁）。记录患者手术时间、术中出血量、术后引流量、术后下地时间和术后住院时间；术前、术后3d、术后12个月和末次随访时采用视觉模拟量表（visual analogue scale，VAS）评分评价颈肩部及上肢疼痛，采用日本骨科协会（Japanese Orthopaedic Association，JOA）评分评价神经功能，计算末次随访时的JOA评分改善率；术前、术后3d和末次随访时在颈椎正侧位X线片上测量C2-7 Cobb角、融合节段Cobb角和椎间隙高度；术后12个月及末次随访时采用Brantigan标准评价植骨融合情况。结果：67例患者均顺利完成手术，未发生脊髓损伤、神经根撕裂、硬膜囊破裂及大血管损伤等严重并发症。Endo-ACDF组手术时间显著性大于ACDF组（100.2±25.3min vs 65.2±15.3min，P<0.05），术中出血量、术后引流量、术后下地时间和术后住院时间均显著性小于ACDF组（20.6±10.7mL vs 42.6±18.7mL、10.0±2.7mL vs 18.0±3.5mL、1.2±0.3d vs 2.5±0.6d、5.1±0.8d vs 6.8±1.0d，P<0.05）。Endo-ACDF组1例术后出现轻微声音嘶哑，经保守治疗后于出院前恢复；两组各有1例出现一过性吞咽不适，未特殊处理自行缓解。随访12～24个月（18.5±3.2个月），与术前相比，两组术后各时间点JOA评分均显著性升高、VAS评分均显著性下降，差异均有统计学意义（P<0.05）；两组同时间点JOA评分和VAS评分比较均无统计学差异（P>0.05），末次随访时JOA评分改善率无统计学差异（P>0.05）。术后和末次随访时的C2-7 Cobb、融合节段Cobb角及椎间隙高度与术前比较均显著性改善，差异均有统计学意义（P<0.05），末次随访与术后3d比较差异无统计学意义（P>0.05）；两组同时间点比较均无统计学差异（P>0.05）。术后12个月及末次随访时两组骨性融合率比较无统计学差异（P>0.05），两组患者均达骨性融合。结论：Endo-ACDF与ACDF治疗CSR均可获得满意的临床疗效和影像学结果，两组在神经功能改善、疼痛缓解、颈椎曲度恢复及椎间融合率方面疗效相当。与ACDF相比，Endo-ACDF具有创伤小、恢复快等微创优势。

英文摘要:

  【Abstract】 Objectives: To compare the clinical efficacies of endoscope-assisted anterior cervical discectomy and fusion(Endo-ACDF) and traditional open anterior cervical discectomy and fusion(ACDF) in the treatment of cervical spondylotic radiculopathy(CSR). Methods: A retrospective analysis was performed on 67 patients with CSR who underwent surgical treatment in our hospital from January 2022 to June 2024. Among them, 32 patients(18 males and 14 females; age 47.6±8.3 years) received Endo-ACDF(Endo-ACDF group), and 35 patients(20 males and 15 females; age 48.4±8.7 years) received traditional ACDF(ACDF group). Operation time, intraoperative blood loss, postoperative drainage volume, time to ambulation, and postoperative hospital stay were recorded. Preoperatively, at 3d, 12 months postoperatively, and final follow-up, neck and upper limb pain was assessed using the visual analogue scale(VAS) score, and neurological function was evaluated using the Japanese Orthopaedic Association(JOA) score, with the JOA score improvement rate calculated at final follow-up. C2-7 Cobb angle, fused segment Cobb angle, and intervertebral disc height were measured on cervical lateral radiographs preoperatively, at 3d postoperatively, and final follow-up. Interbody fusion was assessed using the Brantigan criteria at 12 months postoperatively and final follow-up. Results: All 67 patients successfully underwent the operation without serious complications such as spinal cord injury, nerve root tear, dural tear, or major vascular injury. The operation time in the Endo-ACDF group was significantly longer than that in the ACDF group(100.2±25.3min vs 65.2±15.3min, P<0.05), while intraoperative blood loss, postoperative drainage volume, time to ambulation, and postoperative hospital stay were significantly lower in the Endo-ACDF group than in the ACDF group(20.6±10.7mL vs 42.6±18.7mL, 10.0±2.7mL vs 18.0±3.5mL, 1.2±0.3d vs 2.5±0.6d, 5.1±0.8d vs 6.8±1.0d, P<0.05). One patient in the Endo-ACDF group developed mild hoarseness, which was resolved after conservative treatment before discharge. One patient in each group experienced transient dysphagia, which was resolved spontaneously without special treatment. The mean follow-up period was 18.5±3.2 months(range, 12-24 months). Compared with preoperative values, JOA scores increased significantly and VAS scores decreased significantly at all postoperative time points in both groups(P<0.05). There were no significant differences in JOA scores and VAS scores between the two groups at the same time points(P>0.05), and no significant difference was found in JOA score improvement rate at final follow-up(P>0.05). C2-7 Cobb angle, fused segment Cobb angle, and intervertebral disc height were significantly improved at postoperative and final follow-up time points compared with preoperative values(P<0.05), with no significant differences between the final follow-up and 3d postoperatively(P>0.05); And there were no significant differences between the two groups at the same time points(P>0.05). At 12 months postoperatively and final follow-up, there was no significant difference in bony fusion rate between the two groups(P>0.05), and all patients achieved bony fusion. Conclusions: Both Endo-ACDF and ACDF can achieve satisfactory clinical efficacy and radiographic outcomes in the treatment of CSR, with comparable results in neurological function improvement, pain relief, cervical curvature restoration, and interbody fusion rate. Compared with ACDF, Endo-ACDF offers the advantages of minimally invasive surgery, including less trauma and faster recovery.