低温等离子髓核消融术治疗颈性眩晕近期临床疗效观察

The short-term outcome of percutaneous cervical disc nucleoplasty for the treatment of cervical vertigo

中文关键词:  低温等离子髓核消融术  颈性眩晕  近期临床疗效

英文关键词:Percutaneous cervical disc nucleoplasty  Cervical vertigo  Short-term outcome

中文摘要:

  【摘要】 目的：观察低温等离子髓核消融术（percutaneous cervical discnucleoplasty，PCDN）治疗颈性眩晕近期临床疗效。方法：2010年4月～2013年3月我科采用PCDN治疗颈椎病患者295例，其中颈性眩晕患者92例，61例获得2～3.9年（平均2.7±0.52年）随访，男性20例，女性41例，年龄33～81岁，平均（57.28±10.55）岁，采用改良颈性眩晕及伴随症状评估量表评价术后即刻、术后3个月、术后12个月和末次随访时的有效率。结果：所有患者术中、术后均无神经损伤、感染等并发症发生。术后即刻、术后3个月、术后12个月和末次随访时，61例患者的眩晕及伴随症状的平均改良评分分别为21.75±1.76、25.00±4.00、24.82±4.38、24.64±4.12分，均较术前（18.06±3.25分）明显上升，有效率分别为96.7%、75.4%、72.1%、72.1%。末次随访时，眩晕症状消失或明显缓解的患者占72.1%（44/61），其中治疗节段包含C3/4或C4/5节段者43例（C4/5 30例，C3/4 4例，C3/4、C4/5 9例）；C5/6、C6/7 1例。4例患者于术后12个月前后眩晕症状复发，复发率占6.6%，其中3例予以保守治疗，另1例行颈椎人工间盘置换术，经治疗后症状均获得明显改善。17例随访无效的患者中，4例患者术前TCD显示椎-基底动脉狭窄或椎动脉狭窄；5例患者年龄偏高，术前均合并有高血压病3级；其他患者原因不明。结论：利用PCDN治疗颈性眩晕可以获得较好的近期临床疗效；选择C3/4和/或C4/5节段是取得疗效的关键。

英文摘要:

  【Abstract】 Objectives: To observe the short-term outcome of percutaneous cervical disc nucleoplasty(PCDN) for cervical vertigo. Methods: 295 patients with cervical spondylosis were treated consecutively by PCDN in our hospital from April 2010 to March 2013, 92 of whom were diagnosed as cervical vertigo, 61 of them were followed up for 2-3.9 years. There were 20 males and 41 females with a mean age of 57.28±10.55 years(rang, 33-81 years old). The improvements of each patient′s symptoms were estimated by using themodified evaluation(hereinafter referred to as themodified evaluation), and the effective rate was reviewed by the modified evaluationat at postoperation immediately, 3 months, 12 months and final follow-up respectively. Results: No neurovascular injury and infection were noted. At postoperation immediately, 3 months, 12 months, final follow-up, the modified score was 21.75±1.76, 25.00±4.00, 24.82±4.38, 24.64±4.12 respectively which was significantly higher than preoperative counterpart, the effective rate were 96.7%, 75.4%, 72.1%, 72.1% respectively. At final follow-up, vertigo symptoms disappearing or significant relief were noted in 72.1% patients(44/61), among them, the segment contained C3/4 or C4/5 section were 43 cases(C4/5 in 30 cases, C3/4 in 4 cases, C3/4 and C4/5 in 9 cases); C5/6 and C6/7 in 1 case. Four patients′ vertigo symptoms recurred 12 months later, with a recurrence rate of 6.6%, 3 cases received conservative treatment, the other one underwent cervical artificial disc replacement, the patients gained significant improvement in symptoms after treatment. 17 cases were irresponsible for this method, among them, 4 patients with preoperative vertebrobasilar artery stenosis or vertebral artery stenosis, 5 patients with older age and preoperative hypertension of 3 levels, the other patients with unknown causes. Conclusions: Although the pathogenesis of cervical vertigo are complex and diverse, but the majority of patients can obtain good short-term clinical effect after PCDN treatment.