经皮内镜下颈椎椎间孔减压术与颈椎间盘置换术治疗单节段神经根型颈椎病的疗效比较

Comparison of percutaneous full-endoscopic posterior cervical foraminotomy versus anterior cervical disc replacement for single-level cervical spondylotic radiculopathy

中文关键词:  神经根型颈椎病  椎间孔切开减压术  颈椎间盘置换术  临床疗效

英文关键词:Cervical spondylotic radiculopathy  Cervical foraminotomy  Cervical disc replacement  Clinical efficacy

中文摘要:

  【摘要】 目的：比较经皮内镜下颈椎椎间孔切开减压术（percutaneous full-endoscopic posterior cervical foraminotomy，PE-PCF）与前路颈椎间盘置换术（anterior cervical disc replacement，ACDR）治疗单节段神经根型颈椎病（cervical spondylotic radiculopathy，CSR）的临床疗效。方法：回顾性分析2020年1月~2022年12月在我院治疗的72例单节段CSR患者，其中男49例、女23例，年龄30~70岁（49.2±8.0岁），术后随访14~32个月（18.8±4.2个月）。根据手术方式分为PE-PCF组和ACDR组。两组患者年龄、性别、手术节段、随访时间无统计学差异（P＞0.05）。收集两组患者的手术时间、术中出血量、住院时间；分别于术前、术后3d、术后6个月和末次随访时采用疼痛视觉量表（visual analogue scale，VAS）评分评估颈部及上肢疼痛程度，采用颈部残障功能指数（neck disability index，NDI）评估颈部功能。在术前、术后3d及末次随访时的X线片上测量手术节段椎间隙高度（disc heigh，DH）、手术节段活动度（segment range of motion，S-ROM）、颈椎活动度（range of motion，ROM）和颈椎Cobb角（cobb angle，CA）。结果：两组患者均顺利完成手术。PE-PCF组手术时间、术中出血量、住院时间均小于ACDR组，有统计学差异（P＜0.05）。两组术后3d、术后6个月及末次随访时VAS评分、NDI均较术前显著性改善（P＜0.001）；PE-PCF组术后3d上肢VAS评分、NDI优于ACDR组（P＜0.05），两组术后6个月及末次随访时上肢VAS评分、NDI比较无统计学差异（P＞0.05）。两组术后3d、术后6个月及末次随访时的颈部VAS评分无统计学差异（P＞0.05）。PE-PCF组术后3d及末次随访时DH较术前无明显变化（P=0.715）；ACDR组术后及末次随访时DH较术前增加（P<0.001），且各时间点DH均高于PE-PCF组（P<0.001）。两组术后及末次随访时S-ROM均较术前增加（P<0.001），且ACDR组各时间点S-ROM均大于PE-PCF组（P<0.001）。PE-PCF组术后及末次随访时ROM较术前减少（P=0.043）；ACDR组术后及末次随访时ROM较术前无明显变化（P=0.176）；两组间各时间点ROM无显著差异（P＞0.05）。两组术后及末次随访时CA均较术前增加（P<0.05），且ACDR组各时间点CA均大于PE-PCF组（P＜0.001）。结论：PE-PCF及ACDR治疗CSR均能取得良好的疗效，PE-PCF与ACDR相比，手术时间短、出血少、恢复快、住院天数少；ACDR更有利于恢复手术节段椎间隙高度、手术节段活动度及颈椎生理曲度。

英文摘要:

  【Abstract】　Objectives: To compare the clinical efficacy of percutaneous full-endoscopic posterior cervical foraminotomy(PE-PCF) and anterior cervical disc replacement(ACDR) for the treatment of single-level cervical spondylotic radiculopathy(CSR). Methods: 72 patients with single-level CSR treated in our hospital from January 2020 to December 2022 were retrospectively analyzed. The cohort included 49 males and 23 females, aged 30-70 years(49.2±8.0 years). The postoperative follow-up period ranged from 14 to 32 months(18.8±4.2 months). Patients were divided into a PE-PCF group and an ACDR group based on the surgical procedure. No significant differences were observed between the two groups in age, sex, surgical level, or follow-up duration(P>0.05). Operative time, intraoperative blood loss, and length of hospital stay were compared between the two groups. The degree of neck and upper limb pain was assessed using the visual analogue scale(VAS), and the neck functional was evaluated using the neck disability index(NDI) before surgery, at 3d and 6 months postoperatively, and at the final follow-up. The disc height(DH) of the surgical segment, the surgical segment range of motion(S-ROM), the cervical range of motion(ROM), and the cervical Cobb angle(CA) were measured on radiographs obtained preoperatively, at 3d postoperatively, and at the final follow-up. Results: The operation was successfully completed in both groups. The PE-PCF group had significantly shorter operative time, less intraoperative blood loss, and shorter hospital stay compared to the ACDR group(P<0.05). Both groups showed significant improvements in VAS and NDI scores at 3d and 6 months postoperatively and at the final follow-up compared to preoperative values(P<0.001). At 3d postoperatively, the PE-PCF group had significantly better upper limb VAS and NDI scores than the ACDR group(P<0.05); however, no significant intergroup differences were observed at 6 months or at the final follow-up(P>0.05). No significant differences were found in neck pain VAS scores between the two groups at 3d, 6 months, or the final follow-up(P>0.05). In the PE-PCF group, no significant change in DH was observed 3d postoperatively or at the final follow up compared with the preoperative value(P=0.715). In the ACDR group, DH increased postoperatively and at the final follow-up compared with the preoperative value(P<0.001), and DH was higher at all time points than that in the PE-PCF group(P<0.001). In both groups, S-ROM increased postoperatively and at the final follow-up compared with the preoperative value(P<0.001), and S-ROM was greater in the ACDR group than in the PE-PCF group at all time points(P<0.001). ROM decreased in the PE-PCF group at postoperation and final follow-up compared with preoperation(P=0.043). No significant change in ACDR group(P=0.176). No significant between-group differences at any time point(P＞0.05). In both groups, CA increased postoperatively and at the final follow-up compared with the preoperative value(P<0.05), and the CA in the ACDR group was greater than that in the PE-PCF group at all time points(P<0.001). Conclusions: Both PE-PCF and ACDR are effective treatments for CSR. PE-PCF offers advantages of shorter operative time, less blood loss, faster recovery, and shorter hospital stay, whereas ACDR is more beneficial for restoring index-level disc height, segmental mobility, and cervical physiological lordosis.