摘要
目的探讨颈椎后路经皮脊柱内镜椎间盘髓核切除术(posterior percutaneous endoscopic cervical discectomy,PPECD)治疗神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的安全性和临床疗效。方法2014年8月~2017年12月全麻下PPECD治疗37例CSR,比较术前、出院时及末次随访疼痛视觉模拟评分(Visual Analogue Scale,VAS)、颈椎功能障碍指数(neck disability index,NDI),末次随访时采用改良MacNab分级、颈椎动力位片和MRI评估疗效。结果37例顺利完成手术,未出现围术期神经症状加重、脊髓损伤、血管损伤、脑脊液漏、感染等围手术期并发症。37例平均随访21.7月(13~50个月),出院时和末次随访时VAS评分分别为(2.1±0.6)分和(1.6±0.7)分,显著低于术前(6.2±1.0)分(P均=0.000);末次随访时NDI(14.3±3.9)%,显著低于术前(50.8±9.1)%(t=21.025,P=0.000)。末次随访时改良MacNab疗效优24例,良11例,可2例,优良率94.6%,颈椎过伸过屈位X线片未显示明显颈椎失稳。结论严格选择适应证的前提下,PPECD治疗CSR微创、安全,临床疗效满意。
Objective To explore the safety and curative effects of posterior percutaneous endoscopic cervical discectomy(PPECD)for cervical spondylotic radiculopathy(CSR).Methods A retrospective review was performed on 37 patients with CSR who underwent PPECD under general anesthesia from August 2014 to December 2017.Visual analog scale(VAS)and neck disability index score(NDI)were compared before operation,at discharge and at the last follow-up.At the last follow-up,the curative effect was evaluated by modified MacNab classification,cervical dynamic radiographs and MRI.Results All the patients were performed by PPECD successfully without severe perioperative complications such as spinal cord and vascular injury,cerebrospinal fluid leakage or infection.The 37 patients were followed up for an average of 21.7 months(range,13-50 months).The VAS scores were(2.1±0.6)points at discharge and(1.6±0.7)points at the final follow-up,respectively,which were statistically significant as compared to(6.2±1.0)points at the preoperative time(P=0.000).The NDI was(14.3±3.9)%at the final follow-up,significantly lower than preoperative level[(50.8±9.1)%,t=21.025,P=0.000].According to modified MacNab criteria,24 cases obtained excellent outcome,11 good and 2 fair,with an effective rate being 94.6%.No radiographic segmental instability was indicated on dynamic radiographs.Conclusion Based on strict selection of indications,PPECD is a safe and minimally invasive surgery for CSR,with reliable curative effects.
作者
刘东宁
李巍明
刘楷
黄坤
陈侯磬
曾娘华
刘诚
罗万荣
易伟宏
Liu Dongning;Li Weiming;Liu Kai(Department of Spine Surgery, Union Shenzhen Hospital (Nanshan Hospital), Huazhong University of Science and Technology, Shenzhen 518052, China)
出处
《中国微创外科杂志》
CSCD
北大核心
2020年第3期240-244,共5页
Chinese Journal of Minimally Invasive Surgery
基金
深圳市卫计委学科建设能力提升项目(SZXJ2017057)
关键词
神经根型颈椎病
内镜
椎间盘切除术
颈椎后路
Cervical spondylotic radiculopathy
Endoscope
Discectomy
Cervical posterior approach
