2种微创方法治疗包容型颈椎间盘突出症的比较

目的比较经皮穿刺颈椎间盘切吸术(percutaneous cervical discectomy,PCD)和经皮穿刺射频消融髓核成形术(percutaneous coablation nucleoplasty,PCNP)治疗包容型颈椎间盘突出症的疗效、并发症、对椎间稳定性的影响。方法回顾分析2006年1月～2010年6月94例包容型颈椎间盘突出症行PCD(PCD组,n=53)和PCNP(PCNP组,n=41)的临床资料,比较PCD和PCNP治疗颈椎间盘突出症的疗效、手术并发症及对颈椎稳定性的影响。结果 94例均获得随访,PCD组平均随访13个月(5～21个月),PCNP组平均随访11个月(7～15个月)。根据改良MacNab标准,PCD组和PCNP组术后1周优良率分别为83.0%和80.5%(χ2=0.010,P=0.944),术后半年优良率分别为81.1%和78.0%(χ2=0.136,P=0.712),术后1年优良率分别为78.4%和74.4%(χ2=0.205,P=0.651)。PCD组在随访期间内有3例(5.7%)因复发性椎间盘突出改行前路颈椎间盘摘除植骨融合术(anterior cervical discectomy and fusion,ACDF),PCNP组2例(4.9%)因复发性椎间盘突出改行ACDF,2组病人术后均未出现椎间盘炎等不良事件。PCD组术前、术后1周内、术后半年、术后1年椎间高度(intervertebralheight,IVH)分别为(7.14±0.84)、(7.12±0.93)、(7.09±0.78)、(7.11±0.82)mm,与PCNP组相应时点(7.32±0.95)、(7.23±0.87)、(7.21±0.81)、(7.22±0.91)mm比较无统计学差异(P>0.05),随访未见颈椎不稳征象。结论 PCD和PCNP治疗包容型颈椎间盘突出症均能快速缓解患者临床症状。PCD和PCNP治疗颈椎间盘突出症并发症发生率低,术后IVH无明显丢失,对颈椎间的稳定性也无明显影响。PCD和PCNP是2种安全而有效的经皮椎间减压方法。

Comparison between Two Minimally Invasive Approaches for Contained Cervical Disc Herniation

Objective To compare the efficacy of percutaneous cervical discectomy(PCD) and percutaneous coblation nucleoplasty(PCNP) for contained cervical disc herniation,and their complications and influence on the stability of the cervical vertebrae.Methods From January 2006 to June 2010,94 patients with contained cervical herniation were admitted to our hospital,of whom 53 patients received PCD,the other 41 underwent PCNP.The efficacy,complications,and postoperative stability of the cervical vertebrae of the two procedures were compared.Results The mean follow-up time of the PCD group was 13 months(ranged from 5 to 21 months) and that of the PCNP group was 11 months(ranged from 7 to 15 months).The excellent and good rate at one week,six months and one year postoperation were 83.0% and 80.5%(χ2=0.010,P=0.944),81.1% and 78.0%(χ2=0.136,P=0.712),and 78.4% and 74.4%(χ2=0.205,P=0.651) respectively in the PCD and PCNP groups,by modified MacNab criterion.During the follow-up,3 patients(5.7%) in the PCD group and 2 patients(4.9%) in the PCNP group were converted to anterior cervical discectomy and fusion(ACDF) because of recurrent disc herniation.No patients had discitis or abscess formation after the surgery.The preoperative,and 1-week,half-year,and 1-year postoperative intervertebral height(IVH) were(7.14±0.84) mm,(7.12±0.93) mm,(7.09±0.78) mm,and(7.11±0.82) mm in the PCD group,respectively,which were not significantly different from those of the PCNP group [(7.32±0.95) mm,(7.23±0.87) mm,(7.21±0.81) mm,and(7.22±0.91) mm,P>0.05].No signs suggested unstable cervical vertebrae after the surgery.Conclusions Both PCD and PCNP can relieve the symptoms of contained cervical disc herniation quickly with a low rate of compilation and little change of IVH postoperation,without influencing cervical stability.They are safe and effective approaches for percutaneous disc decompression.