朱旻宇,滕红林,黄克伦,王 宇,林超伟,吴诗阳,王建洪.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[J].中国脊柱脊髓杂志,2018,(6):488-495. |
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 |
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 |
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。 |
Clinical application of posterior percutaneous endoscopic cervical discectomy in the treatment of cervical spondylotic radiculopathy |
英文关键词:Posterior approach Percutaneous Endoscopic Cervical discectomy Cervical spondylotic radiculopathy |
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. |
投稿时间:2017-12-30 修订日期:2018-06-05 |
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