软质内镜辅助下单节段颈椎人工椎间盘置换术治疗颈椎病的近期疗效

Short-term effect of soft endoscope-assisted single-segment cervical artificial disc replacement in the treatment of cervical spondylosis

中文关键词:  颈椎病  颈椎人工椎间盘置换术  软质内镜  微创手术

英文关键词:Cervical spondylosis  Artificial disc replacement  Soft endoscope  Minimally invasive surgery

中文摘要:

  【摘要】 目的：探讨软质内镜辅助下单节段颈人工椎间盘置换术治疗颈椎病的近期疗效。方法：回顾性分析2023年6月~2024年5月在我院接受软质内镜辅助下单节段颈椎人工椎间盘置换术治疗的24例颈椎病患者的临床资料，其中男8例，女16例；年龄25～68岁（47.0±11.9岁）；神经根型颈椎病7例，脊髓型颈椎病14例，混合型颈椎病3例；均为单节段病变，其中C3/4 2例，C4/5 6例，C5/6 12例，C6/7 4例。记录手术切口长度、术中出血量、手术时间、术后引流量、住院时间及并发症发生情况；评估椎前软组织水肿情况；术前1d、术后1周、术后1个月及术后3个月采用日本骨科协会（Japanese Orthopaedic Association，JOA）评分评估颈椎功能，采用视觉模拟量表（visual analog scale，VAS）评分评估颈肩部疼痛情况。结果：所有患者手术顺利完成，术中未发现脊髓/神经根损伤、脑脊液漏等并发症，手术时间34～123min（66.6±20.8min）；手术切口长度2.5～3cm（2.6±0.2cm）；术中出血量5～50mL（19.6±12.6mL）；术后引流量0～60mL（13.5±18.8mL）；术后住院时间3～8d（5.1±1.6d）。术后未观察到颈椎皮下血肿及吞咽障碍等并发症发生；影像学复查未发现显著椎前软组织水肿。术后各时间点VAS评分和JOA评分与术前比较均显著性改善（P＜0.05），术后3个月随访时根据JOA评分改善率评定综合疗效：优12例，良12例，优良率100%（24/24）。结论：软质内镜辅助下单节段颈椎人工椎间盘置换术治疗颈椎病创伤小、手术时间短，具有一定的临床应用前景。

英文摘要:

  【Abstract】 Objectives: To investigate the short-term effect of soft endoscope-assisted single-segment cervical artificial disc replacement(ADR) in the treatment of cervical spondylosis. Methods: A retrospective analysis was conducted on the clinical data of 24 cases of cervical spondylosis treated with soft endoscope-assisted single-segment ADR in our hospital from June 2023 to May 2024, of which, 8 cases were male and 16 cases were female, aged 25 to 68 years old(47.0±11.9 years old). There were 7 cases of cervical spondylotic radiculopathy, 14 cases of cervical spondylotic myelopathy, and 3 cases of mixed cervical spondylosis. All of the patients were with single-segment lesions, including 2 cases of C3/4, 6 cases of C4/5, 12 cases of C5/6, and 4 cases of C6/7. The length of surgical incision, intraoperative bleeding, operative time, postoperative drainage, hospitalization time and complications were recorded; Prevertebral soft tissue edema was evaluated; Japanese Orthopaedic Association(JOA) score was assessed for cervical spine motor function, and visual analog scale(VAS) score was evaluated for neck and shoulder pain on 1d before surgery, at 1 week after surgery, 1 month and 3 months after surgery. Results: Surgery was successfully completed in all patients, and no complications such as spinal cord/nerve root injury or cerebrospinal fluid leakage were detected during the operation. Operative time was 34-123min(66.6±20.8min), length of surgical incision was 2.5-3cm(2.6±0.2cm), intraoperative bleeding volume was 5-50mL(19.6±12.6mL), postoperative drainage volume was 0-60mL(13.5±18.8mL), and postoperative hospitalization time was 3-8d(5.1±1.6d). No postoperative complications such as cervical subcutaneous hematoma and dysphagia were observed. Postoperative imaging revealed no significant prevertebral soft tissue edema. The postoperative VAS and J0A scores were significantly improved at all time points compared with the preoperative values(P<0.05). The overall efficacy was assessed according to the improvement rate of JOA score at 3 months after surgery: 12 cases were excellent, 12 cases were good, and the rate of excellent and good was 100%(24/24). Conclusions: Soft endoscope-assisted single-segment ADR for the treatment of cervical spondylosis is small in trauma and short in operative time, which has certain clinical application prospects.