后路经皮内镜与前路间盘切除植骨融合术治疗神经根型颈椎病

目的：探讨后路经皮内镜髓核摘除术(posterior percutaneous endoscopic discectomy,PPECD)治疗神经根型颈椎病的临床疗效。方法：对2017年12月至2020年10月外科治疗的56例单节段神经根型颈椎病患者进行回顾性分析。56例患者根据手术方式分为观察组和对照组，观察组27例，男16例，女11例，年龄34～61(51.15±6.29)岁，C_4,58例、C_5,613例、C_6,76例，行经皮内镜髓核摘除术；对照组29例，男19例，女10例，年龄40～65(53.24±5.31)岁，C_4,510例、C_5,614例、C_6,75例，行颈椎间盘切除植骨融合术。比较两组患者的手术时间、术中出血量、卧床时间、住院时间；采用疼痛视觉模拟评分(visual analogue scale,VAS)及颈部残障功能指数(neck disability index,NDI)对临床症状进行评估，并分析两组并发症情况；观察术后影像学资料。结果：5...

Comparative analysis of clinical efficacy between posterior percutaneous endoscopic discectomy and anterior cervical discectomy and fusion in the treatment of cervical spondylotic radiculopathy

Objective To explore the clinical efficacy of posterior percutaneous endoscopic discectomy (PPECD) in the treatment of cervical spondylotic radiculopathy.Methods A total of 56 patiens with single segment cervical spondylotic radiculopathy from December 2017 to October 2020,were randomly divided into observation group and control group.In observation group,there were 16 males and 11 females,including 8 cases of C_4,5,13 cases of C_5,6 and 6 cases of C_6,7 performed posterior percutaneous endoscopic discectomy,aged from 34 to 61 years old with an average of (51.15±6.29) years old.In control group,there were 19 males and 10 females with single segment cervical spondylotic radiculopathy including 10 cases of C_4,5,14 cases of C_5,6 and 5 cases of C_6,7 performed anterior cervical discectomy and fusion,aged from 40 to 65 years old with an average of (53.24±5.31) years old.The operative time,intraoperative blood loss,postoperative time of lying in bed and length of postoperative hospital stay were recorded.Visual analogue scale (VAS) and neck disability index (NDI) were used to evaluate the clinical efficacy.Cervical plain films or MRIs,CTs were taken for re-visiting patients.Results All patients were followed up more than 2 years.The observation group patients were followed up,the duration ranged from 24 to 42 months with an average of (30.48±4.91) months.The control group patients were followed up,the duration ranged from 25 to 47 months,with an average of (32.76±4.53) months.Compared with control group,operative time,intraoperative blood loss,postoperative time of lying in bed and length of postoperative hospital stay were decreased (P<0.05).Compared with pre-operation,VAS of neck and upper limb and NDI at the latest follow-up between two groups were significantly improved (P<0.05).Compared with control group,VAS of neck and upper limb at 1 day after operation in observation group were significantly reduced (P<0.05).There was no significant difference in VAS of neck and upper limb and NID at 1,3 months and the latest follow-up after operation between two groups (P>0.05).In the observation group,one patient''s deltoid muscle strength was weakened to grade 4 after operation,and returned to normal after 12 weeks of conservative treatment.In control group,there was 1 case of postoperative adjacent spondylosis with symptoms of spinal compression after 2 years operation,then underwent cervical artificial intervertebral disc replacement.And there was 1 case of dysphagia after operation in control group and improved after 1 year.There was no significant difference in incidence of complications between two groups.Conclusion PPECD has advantages of shortening operative time,decreasing intraoperative blood loss,reducing postoperative time of lying in bed and length of postoperative hospital stay.However,applicable age range of patients and long-term clinical efficacy needs further study.