颈椎Key-hole技术与颈前路Zero-P系统治疗神经根型颈椎病的病例对照研究

目的:探讨脊柱内镜下颈后路开窗减压髓核摘除术(Key-hole)和颈前路零切迹椎间植骨融合内固定系统(zero profile intervertebral fusion system,Zero-P)治疗单节段神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的短期临床疗效。方法:回顾性分析2017年1月至2020年1月因神经根型颈椎病行手术治疗的45例患者,根据不同的手术方式分为Key-hole组和Zero-P组,其中Key-hole组21例(男12例,女9例),随访时间10~22(13.2±2.3)个月;Zero-P组24例(男14例,女10例),随访时间10~23(12.7±1.9)个月。比较两组手术的围手术期情况(手术切口长度、术中出血量、手术时间、住院时间、并发症情况等),分别于术前和术后即刻及末次随访时拍摄颈椎正侧位X线片评价颈椎曲度,并根据手术前后疼痛视觉模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry Disability Index,ODI)以及颈椎日本骨科协会(Japanese Orthopaedic Association,JOA)评分来评价临床疗效。结果:Key-hole组与Zero-P组手术切口长度、术中出血量、手术时间、末次随访Cobb角度及术后即刻VAS评分分别为(1.2±0.2)cm,(5.3±0.3)cm;(35.3±9.7)ml,(120.2±13.5)ml;(56.4±11.3)min,(90.6±12.6)min;(3.2±3.9)°,(7.3±3.8)°;(2.8±1.2)分,(3.8±1.1)分;Zero-P组均大于Key-hole组(P<0.05)。两组患者住院时间、ODI及JOA评分组间比较差异无统计学意义(P>0.05)。术后随访Key-hole组出现1例神经刺激症状经保守治疗缓解,2例因颈椎间盘突出复发再次手术治疗后好转;Zero-P组出现2例神经刺激症状,2例咽部不适,1例硬脊膜撕裂,均经保守治疗缓解。结论:颈椎Key-hole技术与颈前路Zero-P系统治疗神经根型颈椎病疗效相近,Key-hole技术在切口长度、术中出血、手术时间上有一定优势,是一种安全、有效、可以深度推广和运用的颈椎手术方式。

A case control study of cervical spine Key-hole technique and anterior cervical Zero-P system in the treatment of cervical spondylotic radiculopathy

Objective: To explore the short term clinical efficacy of single stage cervical spondylotic radiculopathy (CSR) between the minimally invasive Key hole technique and anterior cervical Zero profile intervertebral fusion system (Zero-P).Methods: A retrospective analysis was performed on 45 patients who underwent surgical treatment for CSR from January 2017 to January 2020,including 21 in Key hole group (12 males and 9 females),followed up for 10-22(13.2±2.3) months;24 cases in Zero-P group (14 males and 10 females),and the follow up period was 10 to 23(12.7±1.9) months. Perioperative conditions (incision length,intraoperative blood loss,operation time,length of hospital stay,and complications) were compared between two groups,and X rays of cervical spine before and after surgery and at the final follow up were taken to analyzed curvature of the cervical spine,visual analogue scale(VAS) of pain before and after surgery,Oswestry Disability Index(ODI) and Japanese Orthopaedic Association (JOA) score of cervical spine were recorded to evaluate clinical efficacy.Results: In Key hole group and Zero-P group,the surgical incision length,intraoperative blood loss,operation time,final follow up Cobb angle and imme- diate postoperative VAS score respectively were (1.2±0.2) cm,(5.3±0.3) cm;(35.3±9.7) ml,(120.2±13.5) ml;(56.4±11.3) min,(90.6±12.6) min;(3.2±3.9)°,(7.3±3.8)°;(2.8±1.2)points,(3.8±1.1) points;the Zero-P group was larger than the Key hole group,with statistical significance(P<0.05). There were no statistically significant difference in length of hospital stay,O- DI and JOA scores between two groups (P>0.05). After the follow up,1 case of neurostimulation symptoms in Key hole group was relieved by conservative treatment,2 cases improved after reoperation due to recurrence of cervical disc herniation;2 cases of neurostimulation symptoms in Zero-P group,2 cases of throat discomfort,and 1 case dural tears were all relieved by conser- vative treatment.Conclusion: The cervical spine Key hole technology is similar to the anterior cervical Zero-P system in the treatment of CSR. The Key hole technique has certain advantages in incision length,intraoperative blood loss,and operation time. It is a safe,effective and can be widely used cervical spine surgery method.