大通道内镜下后路颈椎椎管减压术治疗多节段脊髓型颈椎病的疗效及对颈椎矢状面形态的影响

Clinical efficacy of large-channel endoscopic posterior cervical spinal canal decompression in treating multilevel cervical spondylotic myelopathy and effects on cervical sagittal morphology

中文关键词:  脊髓型颈椎病  多节段  内镜下后路颈椎椎管减压术  颈椎矢状面形态

英文关键词:Cervical spondylotic myelopathy  Multilevel  Endoscopic posterior cervical canal decompression  Cervical sagittal plane morphology

中文摘要:

  【摘要】 目的：探讨大通道内镜下后路颈椎椎管减压术治疗多节段脊髓型颈椎病（multilevel cervical spondylotic myelopathy，MCSM）的疗效以及对颈椎矢状面形态学的影响。方法：回顾性分析2022年6月~2024年6月在我院脊柱外科行大通道内镜下后路颈椎椎管减压术（endoscopic posterior cervical canal decompression，Endo-PCCD）的34例MCSM患者，男19例，女15例，年龄36~78岁（62.7±9.6岁）；双节段13例（C3~C5 7例，C5~C7 6例），3节段20例（C3~Ｃ6 19例，C4~Ｃ7 1例），4节段1例（C3~Ｃ7）。记录手术时间、术后引流量和并发症情况，收集术前、术后3个月、术后6个月的日本骨科协会（Japanese Orthopaedic Association，JOA）评分，疼痛视觉模拟量表（visual analogue scale，VAS）评分和颈椎功能障碍指数（neck disability index，NDI），在X线片上测量并比较C2-7 Cobb角、T1倾斜角（T1 slope，T1S）、C2-7颈椎矢状面轴向距离（sagittal vertical axis，SVA）。结果：34例患者均顺利完成手术，手术时间112~176min（135.2±38.5min）；术后24h引流量均小于50mL。术后2例患者手术切口区域疼痛明显，加用300mg加巴喷丁后疼痛缓解；1例患者出现C5神经根麻痹，右肩外展无力，于术后4个月时恢复。术前、术后3个月和6个月时的JOA评分分别为9.35±1.31分、12.47±1.18分和14.58±0.92分，NDI分别为（34.41±5.34）%、（23.07±2.94）%和（15.91±3.32）%；VAS评分分别为5.32±1.02分、2.10±0.96分和1.88±0.95分；C2-7 Cobb角分别为10.37°±3.48°、12.64°±3.28°和14.59°±3.57°,T1S分别为29.24°±7.72°、24.82°±7.26°和23.43°±8.51°；C2-7 SVA分别为22.12±6.24mm、18.34±5.72mm和17.28±5.44mm, 与术前相比，术后3个月和6个月时的J0A评分和C2-7 Cobb角均显著性升高（P＜0.05），VAS评分、NDI、T1S和C2-7 SVA均显著性减小（P＜0.05）。与术后3个月时相比，术后6个月时JOA评分、NDI、C2-7 Cobb角存在显著性差异（P＜0.05）。结论：Endo-PCCD治疗MCSM可获得显著临床疗效，术后颈椎矢状面形态得到一定程度的改善。

英文摘要:

  【Abstract】　Objectives: To investigate the efficacy of large-channel endoscopic posterior cervical canal decompression(Endo-PCCD) for multilevel cervical spondylotic myelopathy(MCSM) and its impact on cervical sagittal morphology. Methods: A retrospective analysis was conducted on 34 patients with MCSM who underwent large-channel Endo-PCCD in the Department of Orthopedics Surgery from June 2022 to June 2024. There were 19 males and 15 females, aged 36-78 years(62.7±9.6 years). 13 patients had two-level involvement(C3-C5: 7 cases, C5-C7: 6 cases), 20 patients had three-level involvement(C3-C6: 19 cases, C4-C7: 1 case), and 1 patient had four-level involvement(C3-C7). The operative time, postoperative drainage volume, and complications were recorded. The Japanese Orthopaedic Association(JOA) score, visual analogue scale(VAS) score, and neck disability index(NDI) were collected, and C2-7 Cobb angle, T1 slope(T1S), and C2-7 sagittal vertical axis(SVA) were measured on X-ray images preoperatively, at 3 months and 6 months postoperatively. Results: All 34 patients successfully underwent large-channel Endo-PCCD. The operative time ranged from 112 to 176min(135.2±38.5min). The 24h postoperative drainage volume was less than 50mL in all patients. Two patients experienced significant pain at the surgical incision area, which was relieved after adding 300mg of gabapentin. One patient developed C5 nerve root palsy with right shoulder abduction weakness postoperatively, which recovered at 4 months after surgery. At preoperation, 3 months and 6 months postoperatively, the JOA scores were 9.35±1.31, 12.47±1.18, and 14.58±0.92, respectively; The NDI values were (34.41±5.34)%, (23.07±2.94)%, and (15.91±3.32)%, respectively; The VAS scores were 5.32±1.02, 2.10±0.96, and 1.88±0.95, respectively; The C2-7 Cobb angles were 10.37°±3.48°, 12.64°±3.28°, and 14.59°±3.57°, respectively; The T1S values were 29.24°±7.72°, 24.82°±7.26°, and 23.43°±8.51°, respectively; And the C2-7 SVA values were 22.12±6.24mm, 18.34±5.72mm, and 17.28±5.44mm, respectively. Compared with preoperative values, the JOA scores and C2-7 Cobb angles at 3 and 6 months postoperatively were significantly increased(P<0.05), while the VAS scores, NDI, T1S, and C2-7 SVA were significantly decreased(P<0.05). Compared with the 3-month postoperative values, there were significant differences in JOA score, NDI, and C2-7 Cobb angle at 6 months postoperatively(P<0.05). Conclusions: Endo-PCCD not only demonstrates significant clinical efficacy in treating MCSM, but also results in a certain degree of improvement in postoperative cervical sagittal morphology.