颈椎小关节阻滞术及PLDD术临床疗效观察

目的探讨颈椎小关节阻滞术和颈椎经皮激光间盘臧压术（percutaneous laser disc decompression，PLDD）对颈间盘膨出型同时伴有交感神经及周围神经刺激症状的颈椎病患者的临床疗效进行分析。方法2009年11月至2011年12月在哈尔滨医科大学附属第二医院骨三科对322例患者进行回顾性分析。随访至少3个月，最长2．9年，平均随访1．4年。术前常规给予X线片及颈椎MRI检查。分别行颈椎小关节阻滞术和颈椎PLDD术，术后均给予药物治疗，术后患者无一例并发症。在临床随访中以改良的Macnab标准进行评估。本次回访为颈椎病所致临床症状，包括交感神经及周围神经刺激症状。交感神经症状包括眩晕、头痛。周围神经刺激症状包括颈痛、不适及上肢疼痛、麻木等。根据l临床满意率进行评价。结果Logistic回归模型中进行多因素分析，在控制其他因素的前提下，颈椎小关节阻滞术与PI，DD术比较效果要差，其OR值为4．027，95％置信区间为2．349～6．910，也就是说PLDD术的疗效要比颈椎小关节阻滞术好。PLDD术优于颈椎小关节阻滞术治疗（P〈0．01）。结论经随访，颈椎PLDD术优于颈椎小关节阻滞术。

On 322 Cases of Clinical Efficacy of Cervical Facet Block Technique and PLDD Surgery

Objective In order to investigate the clinical effectiveness of the cervical facet block technique and cervical percutaneous laser disc decompression. The patients were investigated with cervical collar disk bulging accompanied with sympathetic and peripheral nerve irritation symptoms. Methods 322 patients were analyzed and retrospected,during November 12,2009-December 30,2011. They were followed up for at least three months and a maximum of 2.9 years ,with an average of 1.4 years, all patients unleruent X-ray and cervical spine MRI. The cervical facet Mock surgery and cervical PLDD surgery were given to the patients respectively. There was no complications occoured. All patients were evaluated with the modified Macnab criteria. The return visit of clinical symptoms caused by cervical spondylosis ,included sympathetic and peripheral nerve irritation symptoms. Sympathetic symptoms included dizziness and headache. Peripheral nerve irritation symptoms included neck pain, discomfort and upper extremity pain, numb- ness. Results Logistic regression model was used for multivariate analysis. Controling of other factors,compared with the cervical facet block technique ,PLI）D surgery effect was better ,OR： 4. 027,95 % confidence interval 2. 849 to 6. 910. （P〈0.01）. Conclusion Cervical PLDD surgery was superior to the cervical facet joint block.