摘要
目的观察内窥镜下前路颈椎间盘切除及椎间融合术的临床疗效。方法自2002年10月,对26例患者实施内窥镜下前路颈椎间盘切除及椎间融合术。其中获得3个月以上随访者16例,男12例,女4例;年龄23～65岁,平均53.2岁。颈椎外伤合并椎间盘突出症3例,脊髓型颈椎病8例,孤立性颈椎后纵韧带骨化2例,神经根型颈椎病3例。单间隙4例,双间隙12例。病变节段:C3,42个,C4,511个,C5,613个,C6,72个。术前ADL评分平均7.2分。于内窥镜下施行手术,彻底减压后植入PEEK椎间融合器。结果手术时间50～150min,平均120min。术中出血量40～140ml,平均110ml。无一例发生术中并发症,无一例改为开放手术。术后无咽喉部刺激症状,切口内出血1例。16例患者随访3～8个月,平均6.5个月。术后ADL评分平均13.1分,ADL改善率为60.2%。结论内窥镜下实施前路颈椎间盘切除及椎间融合术具有切口小、组织损伤轻、手术操作安全等优点。适用于C3,4～C5,6区域内的颈椎间盘突出症、脊髓型颈椎病、神经根型颈椎病、位于椎间隙的孤立性后纵韧带骨化症、颈椎外伤导致的单间隙椎间盘损伤合并颈椎不稳者。
Objective To report the results using endoscopic techniques in ce rvical discectomy and intervertebral fusion. Methods From October 2002 to August 2003, 26 patients underwent cervical discectomy and intervertebral fusion using endoscopic techniques. 16 patients had been followed-up more than 3 months, inc luding 4 females and 12 males. The average age was 53.2 years (range, 23 to 65 y ears). The disorders lasted from 3 to 14 months before surgery. There were 3 cas es of cervical injury associated cervical disc herniation (CDH), 8 of cervical s pondylotic myelopathy (CSM), 2 of solitary ossification of the posterior longitu dinal ligament (OPLL), and 3 of radiculopathy. The mean preoperative ADL of Japa nese Orthopedic Association (JOA) score was 7.2. The working channel was inserte d through a 2 cm long incision, the protruded discs or ossified posterior longit udinal ligaments were excised for complete decompression, then an appropriate in tervertebral PEEK fusion cage was implanted. Results All patients obtained endos copic cervical discectomy and interbody fusion successfully. None of cases was c onverted to open procedures. The surgery lasted an average of 120 min (range, 50 to 150 min), mean blood loss was 110 ml (range, from 40 to 140 ml). There was n o complication during operation and no any stimulating symptoms on laryngopharyn x after surgery. However, postoperative hemorrhage of the incision occurred in 1 case, then an injury of a thyroid vessel was found during immediate exploration . The follow-up period extended from 3 to 8 months (mean, 6.5 months), the aver age preoperative ADL of JOA score was 13.1 while the improvement rate was 60.2%. Conclusion The cervical discectomy and intervertebral fusion through endoscopi c approach is able to reduce the soft tissue injury and the incidence of stimula ting symptoms on laryngopharynx, which makes the surgery more safe. The indicati ons for this procedure include cervical disc herniation, cervical myelopathy, ra diculopathy, and traumatic cervical disc injury on C3,4 to C5,6 segments.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2004年第2期80-83,共4页
Chinese Journal of Orthopaedics
