经皮椎间孔镜后路治疗神经根型颈椎病早期疗效观察

目的 :探讨经皮椎间孔镜技术后路治疗神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的早期临床疗效和安全性。方法:2016年8月至2017年9月收治14例CSR患者,其中男6例,女8例;年龄32~68(40.5±7.6)岁;病程0.5~13.0(6.0±1.3)个月。涉及节段:C_(4,5)2例,C_(5,6)8例,C_(6,7)4例。所有患者经6周以上非手术治疗,疗效欠佳,采用后路经皮椎间孔镜全内镜下髓核摘除术治疗。测定患者术前及末次随访时的颈肩疼痛视觉模拟评分(visual analogue scale,VAS),日本骨科学会(Japanese Orthopaedic Association,JOA)颈椎病评分,简明健康状况调查表(short form 36 health survey questionnaire,SF-36)评分及椎体水平位移和椎体角度位移,并记录治疗及随访期间的并发症发生情况。结果:所有患者顺利完成手术,未出现脊髓、神经根血管损伤情况。手术时间60~100 min,中位数75 min;术中出血30~80 ml,中位数40 ml。14例患者均获得随访,时间2~13个月,中位数9个月。随访期间患者的颈肩疼痛症状均明显缓解未见复发,原手术节段未见再次髓核突出,邻近椎体无明显退变征象。与术前相比,末次随访时患者的颈肩疼痛VAS评分明显减小(P0.05),JOA评分和SF-36评分均明显提高(P0.05);椎体水平位移和椎体角度位移与术前相比,差异均无统计学意义(P0.05)。末次随访时,患者颈椎曲度(11.23±0.99)°高于治疗前的(7.75±0.79)°(t=10.280,P=0.000),病变椎间高度(5.52±0.61)mm与治疗前的(5.65±0.5)mm比较,差异无统计学意义(t=0.623,P=0.539)。结论 :经皮椎间孔镜后路髓核摘除术可有效减轻单节段CSR患者的颈肩疼痛症状,改善神经功能,提高患者的生活质量,而且不影响颈椎的稳定性,安全性高,值得临床推广应用。

Observation of early clinical effect of percutaneous transforaminal endoscopic technology in treating cervical spondylotic radiculopathy

Objective: To explore the early clinical effect and safety of percutaneous transforaminal endoscopic technology for cervical spondylotic radiculopathy.Methods: From August 2016 to September 2017,14 patients with cervical spondylotic radiculopathy who responded poorly to non-surgical treatment for at least 6 weeks underwent percutaneous transforaminal endoscopic discectomy via posterior approach. There were 6 males and 8 females,aging from 32 to 68 years old with an average of (40.5±7.6) years. The course of disease ranged from 0.5 to 13.0 months with an average of (6.0±1.33) months. The lesions involved C_4,5 in 2 cases,C_5,6 in 8 cases,C_6,7 in 4 cases. Visual analogue scale (VAS),Japanese Orthopedic Association (JOA),Short Form 36 health survey questionnaire(SF-36) were recorded preoperatively and during the latest follow-up to evaluate the clinical outcome. Horizontal displacement and angular displacement of vertebral body were measured by cervical dynamic X-rays.Results: All operations were successful. No spinal cord injury,nerve root or vascular injuries were found. Operation time was from 60 to 100 min with a median of 75 min;intraoperative bleeding was from 30 to 80 ml with a median of 40 ml. All patients were followed up for 2 to 13 months with a median of 9 months. During the follow-up period,the patients with neck and shoulder pain were significantly relieved without recurrence. No nucleus pulposus protrusion was found in the primary surgical segment,and there was no obvious sign of degeneration in the adjacent vertebral body. At the latest follow-up,VAS,JOA and SF-36 scores were obviously improved(P<0.05). There was no significant difference in horizontal displacement and angular displacement of vertebral body before and after the operation (P>0.05). The cervical curvature at the latest follow-up was higher than preoperative findings (P<0.05). And there was no significant difference in intervertebral disc height preoperatively and postoperatively(P>0.05).Conclusion: Percutaneous transforaminal endoscopic discectomy in treating cervical spondylotic radiculopathy can effectively and safely relieve neck and shoulder pain,improving nerve function,enhance life quality,maintaining cervical stability. It is worthwhile to generalize and apply in clinical settings.