后路经皮内窥镜下颈椎间盘切除术治疗神经根型颈椎病的临床应用

Clinical application of posterior percutaneous endoscopic cervical discectomy in the treatment of cervical spondylotic radiculopathy

中文关键词:  后路  经皮  脊柱内镜  椎间盘切除术  神经根型颈椎病

英文关键词:Posterior approach  Percutaneous  Endoscopic  Cervical discectomy  Cervical spondylotic radiculopathy

中文摘要:

  【摘要】 目的：评价后路经皮内窥镜下颈椎间盘切除术（posterior percutaneous endoscopic cervical discectomy，PPECD）治疗神经根型颈椎病的临床应用价值。方法：2013年1月～2016年10月，共有43例单节段神经根型颈椎病患者入选，随机分入两个手术组并获得至少1年随访。其中采用颈前路减压椎间植骨融合内固定术（anterior cervical decompression and fusion，ACDF）治疗23例，随访时间23.1±5.9个月；采用PPECD治疗20例，随访时间25.6±8.3个月。比较两组患者的手术时间、术后住院天数、住院费用、术前及术后各随访点（1d、1周、1个月、3个月、1年）的上肢疼痛VAS评分、创口疼痛VAS评分，术前及术后1年颈椎前凸Cobb角、颈椎活动度、颈椎功能障碍指数（neck disability index，NDI）评分、轴性症状发生率、重返工作岗位时间等情况，记录术后并发症情况，并在术后1年随访时进行Macnab临床疗效评价。结果：两组平均手术时间无显著性差异（P＞0.05），术后1d时ACDF组及PPECD组的上肢疼痛VAS评分分别为1.13±1.78分、1.02±2.24分，两组间无显著性差异（P＞0.05），且较术前的7.13±1.25分、7.28±1.30分均有显著改善（P＜0.05）；术后1d时PPECD组的创口疼痛VAS评分为1.91±0.58分， 显著小于ACDF组的3.87±1.19分（P＜0.05），但术后1周后随访两组间无显著性差异（P＞0.05）。此外，PPECD组在平均术后住院天数、住院费用、重返工作岗位时间等方面均显著小于ACDF组（P＜0.05）。ACDF组和PPECD组术后1年时颈椎前凸Cobb角分别为13.7°±6.9°和8.2°±4.8°，较术前的4.3°±11.3°、4.7°±8.9°均有显著增大（P＜0.05），且ACDF组的平均增幅显著大于PPECD组（P＜0.05）。术后1年时PPECD组的颈椎活动度同术前无显著性差异（P＞0.05），但ACDF组较术前显著减小（P＜0.05）。术后1年时NDI评分、轴性症状发生率及Macnab临床疗效评价优良率方面两组间无显著性差异（P＞0.05）。结论：PPECD治疗神经根型颈椎病的临床疗效与ACDF相当，但前者手术创伤更小，术后恢复更快，费用更少，可作为临床治疗的术式选择。

英文摘要:

  【Abstract】 Objectives: Through clinical comparative study, the clinical application value and advantages and disadvantages of posterior percutaneous endoscopic cervical discectomy(PPECD) in the treatment of radicular cervical spondylosis were evaluated. Methods: A prospective study. A total of 43 patients who were treated for cervical spondylotic radiculopathy between January 2013 and October 2016 were prospectively included in the study and obtained at least 1-year follow-up. The patients were randomly divided into the anterior cervical discectomy and fusion(ACDF) group with 23 patients and the PPECD group with 20 patients, follow-up for 23.1±5.9 month and 25.6±8.3 month respectively. The patient′s surgical time, length of hospitalization, inpatients expenses, pre-operative and post-operative upper limb VAS, surgical incision VAS, pre- and post-operative 1-year cervical Cobb angle, cervical motion range, neck disability index(NDI) score, rate of cervical axis symptom, the time return to work and post-operative 1-year Macnab score was analyzed. Results: The difference in surgical time was statistically insignificant(P＞0.05). At post-operative 1d, the upper limp VAS changed from 7.13±1.25 to 1.37±0.71 for the ACDF group and from 7.28±1.30 to 1.45±0.81 for the PPECD group. The change between pre- and post-operation upper limb VAS was statistically significant(P<0.05), but the difference between both groups at post-operative 1d was statistically insignificant(P>0.05). At post-operative 1d, the difference in surgical incision VAS was statistically significant(P<0.05) where the ACDF group(3.87±1.19) was greater than the PPECD group(1.91±0.58). However, at post-operative 1 week, the difference in surgical incision VAS was statistically insignificant(P>0.05). The length of hospital stays, inpatient expenses and the time return to work in PPECD group was significantly lower than ACDF group(P<0.05). The pre- and post-operative 1-year cervical Cobb angle for the ACDF group was 4.3°±11.3° and 13.7°±6.9° respectively; the difference was statistically significant(P<0.05) whereas pre- and post-operative 1-year cervical Cobb angle for the PPECD group was 4.7°±8.9° and 8.2°±4.8° respectively where the difference was statistically insignificant(P>0.05). The range of cervical motion in ACDF group decreased significantly(P>0.05) but in the PPECD group, no obvious decrease in range of motion was observed(P>0.05). The NDI score, rate of post-operation cervical axis symptom and Macnab score in both groups showed no difference at post-operative 1 year follow-up(P>0.05). Conclusions: The clinical effectiveness of PPECD and ACDF in treating cervical spondylotic radiculopathy is equivalent. However, PPECD can be favored due to the surgical incision, inpatient expenses, post-operative recovery.