O型臂导航辅助经皮内镜下Key-hole术式治疗神经根型颈椎病的临床疗效

Clinical efficacy of O-arm navigation assisted percutaneous endoscopic Key-hole procedure in single-segment cervical spondylotic radiculopathy

中文关键词:  神经根型颈椎病  O型臂导航  脊柱内镜  Key-hole术式

英文关键词:O-arm navigation  Spinal endoscopy  Key-hole procedure  Cervical spondylotic radiculopathy

中文摘要:

  【摘要】 目的：评价O型臂导航辅助经皮内镜下Key-hole术式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2018年9月~2020年6月在我院接受O型臂导航辅助经皮内镜下Key-hole术式治疗的单节段CSR患者22例，其中男14例，女8例，年龄54.05±10.67岁（32~71岁）；C5/6节段8例，C6/7节段13例，C7/T1节段1例。记录手术时间、术中出血量、术后住院时间及并发症情况；术前、术后3d及末次随访时采用视觉模拟评分量表（visual analogue scale，VAS）、颈部功能障碍指数（neck disability index，NDI）进行疼痛和功能评定，末次随访时根据改良Macnab标准评定疗效；术前、术后3d及末次随访时进行X线片、CT及MRI检查，测量手术节段椎间隙高度（disc height，DH）、下颈椎曲度（cervical spinal angle，CSA）及侧块关节平面切除率（facet resection rate，FRR）。结果：所有患者手术均顺利完成，随访时间36.85±5.83个月（25~44个月）。手术时间为120.32±33.92mins（76~209mins），术中出血量为14.86±12.67ml（2~50ml），术后住院时间为4.05±1.70d（2~9d）。手术并发症3例，其中1例术中C7神经根损伤致右肱三头肌肌力明显下降至2级，末次随访时肌力恢复至5级；1例术中发生椎动脉钳夹损伤出血，即刻使用凝胶海绵填塞止血，术后影像学显示无血肿形成，未诉特殊不适；1例术后出现轻度神经放射痛，经药物治疗后改善。与术前相比，术后3d、末次随访时颈痛VAS评分及NDI均得到显著改善（P<0.05）；末次随访时改良MacNab标准评分优17例、良4例、可1例，优良率为95.5%。术前、术后3d及末次随访时DH分别为4.40±0.97mm、4.31±0.92mm及4.26±1.01mm，CSA分别为5.70°±16.94°、8.43°±15.59°及11.44°±13.80°，术前、术后3d及末次随访时DH及CSA相比较，差异均无统计学意义（P>0.05）。FRR为(27.12±16.62)%。结论：O型臂导航辅助经皮内镜下Key-hole术式治疗CSR安全有效，具有工作套管精准置入，降低手术损伤的优点。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical efficacy of O-arm navigation assisted percutaneous endoscopic Key-hole procedure in single-segment cervical spondylotic radiculopathy(CSR). Methods: Data of 22 patients with single-segment CSR treated with O-arm navigation-assisted posterior percutaneous endoscopic cervical foraminotomy(PPECF), the Key-hole procedure in our hospital from September 2018 to June 2020 were retrospectively analyzed. There were 14 males and 8 females, aged 54.05±10.67 years（32-71 years）, including 8 cases of C5/6, 13 cases of C6/7 and 1 case of C7/T1. Operative time, intraoperative blood loss, length of hospital stay, and complications were recorded; Visual analogue scale(VAS) and neck disability index(NDI) were used for pain and functional assessment before surgery, at 3d after surgery and the last follow-up; And efficacy was assessed according to modified Macnab criteria at the last follow-up. X-ray, CT and MRI were performed before operation, at 3d after operation and final follow-up. The disc height(DH), cervical spinal angle(CSA) and the facet resection rate(FRR) were measured for imaging evaluation. Results: All patients were successfully operated and followed up for 36.86±5.83 months(25-44 months). The average operative time was 120.32±33.92mins(76-209mins), the intraoperative blood loss was 14.86±12.67ml(2-50ml), and the postoperative length of hospital stay was 4.05±1.70d(2-9d). 3 patients developed complications, including 1 case of right tricep muscle strength decreased to grade 2 due to C7 nerve root injury during operation which recovered to grade 5 at final follow-up; One case suffered from vertebral artery clamp injury and bleeding during operation which was treated with gel sponge immediately to stop bleeding, and postoperative imaging showed no hematoma formation; One patient developed mild neuralgia after surgery and improved with medication. Both the last follow-up VAS score and NDI were significantly improved compared with those before surgery(P<0.05). According to modified MacNab criteria, the excellent and good rate was 95.5%, of which 17 cases were excellent, 4 cases were good, and 1 case was medium. The preoperative, postoperative and final follow-up DHs were 4.40±0.97mm, 4.31±0.92mm and 4.26±1.01mm, and CSAs were 5.70°±16.94°, 8.43°±15.59° and 11.44°±13.80°. There was no significant difference between the preoperative, postoperative and final follow-up DHs and CSA(P>0.05). The FRR was (27.12±16.62)%. Conclusions: O-arm navigation assisted percutaneous endoscopic Key-hole procedure is safe and effective in the treatment of CSR, which has the advantages of accurate insertion of working cannula and reduction of surgical injury.