前路减压联合后路内镜手术在 “钳夹式”颈椎病治疗中的应用

目的 探讨颈椎前路减压植骨融合内固定(ACDF)联合后路内镜手术治疗“钳夹式”颈椎病的疗效。方法 回顾性分析。纳入2015年3月-2017年5月河北医科大学第三医院脊柱外科影像学及随访资料完整的28例“钳夹式”颈椎病患者,其中男15例、女13例,年龄33~71(52.214±8.234)岁。接受ACDF的15例患者纳入ACDF组。接受ACDF联合后路内镜手术的13例患者纳入联合手术组。对两组患者术后1年时的颈项部疼痛视觉模拟评分(VAS)及日本骨科协会(JOA)评分、颈椎曲度(Cobb角)、黄韧带面积、椎管矢状径、椎管面积、脊髓面积、椎间隙高度、轴性症状等临床及影像学指标进行比较。结果 两组患者性别、年龄、病程、术前临床表现(颈椎功能障碍指数)、手术节段等基线资料比较,差异均无统计学意义(P值均＞0.05)。两组患者术后各时间点VAS和JOA评分与术前相比,差异均有统计学意义(P值均＜0.01)。联合手术组与ACDF组术后1年Cobb角(10.85°±2.79°、9.33°±3.48°)比较差异无统计学意义(t=-1.255, P＞0.05)。两组患者术后1年时黄韧带面积、椎管矢状径、椎管面积及脊髓面积组间比较差异均有统计学意义(t=9.403、-2.855、-8.007、-2.447, P值均＜0.05),且组内手术前后比较差异均有统计学意义(P值均＜0.01)。术后1年椎间隙高度两组间比较差异无统计学意义(t=-0.534, P＞0.05),但组内手术前后比较差异均有统计学意义(P值均＜0.01)。随访满1年时,两组患者术后轴性症状发生率差异无统计学意义(P=0.705)。结论 联合手术较传统颈椎前路手术,减压更加彻底,更加有利于脊髓功能的恢复,并有效避免了传统后路手术对颈后部软组织的损伤。

Anterior cervical discectomy and fusion combined with posterior percutaneous endoscopic cervical discectomy for the treatment of “pinching” cervical spondylosis

Objective To investigate the efficacy of anterior cervical discectomy and fusion (ACDF)combined with posterior percutaneous endoscopic cervical discectomy (PPECD) for the treatment of “pinching” cervical spondylotic myelopathy.Methods A retrospective analysis was conducted for 28 patients with “pinching” cervical spondylotic myelopathy who were admitted to the Third Hospital of Hebei Medical University from March 2015 to May 2017 with the complete spinal surgery imaging and follow-up data were included. There were 15 males and 13 females. The age was 33-71 (52.214±8.234) years old. Fifteen patients who received anterior cervical decompression and fusion surgery were enrolled in the ACDF group. And 13 patients who received anterior cervical decompression and fusion combined with posterior percutaneous endoscopic cervical discectomy were enrolled in the combined surgery group. After 1 year of follow-up, the cervical visual analogue score(VAS) , the Japan Orthopaedic Association (JOA) score, the cervical curvature (Cobb angle), ligamentum flavum area, spinal canal sagittal diameter, spinal canal area, spinal cord area, inter-vertebral height and axial symptoms were compared between the two groups.Results There were no statistically significant differences in the baseline data such as gender, age, duration of disease, preoperative clinical manifestations (neck disability index score) and operative segment between the two groups (all P values>0.05). During the one year follow-up period, the JOA score and the VAS score of the two groups were significantly improved (all P values<0.01). Compared with the combined surgery group, there was no significant difference in the Cobb angle of the ACDF group after surgery(10.85 °± 2.79°, 9.33°± 3.48°) (t=-1.255, P>0.05). The differences in the ligamentum flavum area, spinal canal sagittal diameter, spinal canal area and spinal cord area at 1 year after surgery were statistically significant between the two groups (t=9.403, -2.855, -8.007, -2.447, all P values<0.05), and there were significant differences between the two groups before and after surgery (all P values<0.01)。 There was no significant difference between the two groups in the inter-vertebral height at 1 year after surgery (t=-0.534, P＞0.05), but there was a significant difference before and after surgery in the two groups(all P values<0.01).When the two groups of patients were followed up for 1 year, it was found that there was no significant difference in the number of postoperative axial symptoms between the two groups (P=0.705).Conclusions The combined surgery is more thorough than the traditional cervical anterior surgery and more conducive to the recovery of spinal cord function.At the same time, it effectively avoids the back of the neck soft tissue damage of the traditional posterior surgery.