单侧双通道内镜下颈椎后路全椎板切除减压术对颈椎管狭窄症的早期疗效及安全性

Early effects of unilateral biportal endoscopic posterior total laminectomy decompression in the treatment of cervical stenosis

探讨单侧双通道内镜(UBE)下颈椎后路全椎板切除减压术治疗颈椎管狭窄症的早期疗效及安全性。回顾性分析2021年1月至2022年10月在河南省直第三人民医院采用UBE下颈椎后路全椎板切除减压治疗的28例单节段颈椎管狭窄症患者的临床资料。其中男16例,女12例,年龄(55.6±9.6)岁;C_(3~4)节段1例,C_(4~5)节段3例,C_(5~6)节段16例,C_(6~7)节段8例。比较术前和术后随访时患者日本骨科协会(JOA)评分;记录术后并发症发生情况;计算末次随访时JOA评分改善优良率。所有患者手术顺利并获得随访,手术时间(43.0±5.3)min,术中出血量(7.9±2.8)ml,术后引流量(8.1±2.3)ml,随访时间(11.6±4.7)个月。JOA评分由术前的(7.9±1.2)分升至术后6个月的(13.5±1.3)分,末次随访则为(13.7±1.2)分,术后与术前差异均有统计学意义(均P<0.001)。术后无脑脊液漏、神经损伤、椎管内血肿等并发症发生;末次随访时通过颈椎X线片或CT评估,手术节段无失稳情况。末次随访时综合疗效:优16例,良7例,中2例,优良率89.3%(25/28)。UBE下颈椎后路全椎板切除减压术治疗单节段颈椎管狭窄症可取得满意疗效,对脊柱稳定性无影响,并具有较高的安全性。

To investigate the early efficacy and safety of unilateral biportal endoscopic posterior total laminectomy decompression in the treatment of cervical stenosis(CS).The clinical data of 28 patients with CS treated by unilateral biportal endoscopic posterior total laminectomy decompression from January 2021 to October 2022 in the Henan NO.3 Provincial People′s Hospital were retrospectively analyzed.Of the patients,16 were male and 12 were female,the mean age was(55.6±9.6)years.The CS occurred at C_(3-4)level in 1 cases,at C_(4-5)level in 3 cases,at C_(5-6)level in 16 cases and at C_(6-7)level in 8 cases.Each case was compared at the moment of pre-operation and final follow-up by the Japanese Orthopedic Association(JOA)score.The postoperative complications were recorded.The JOA improvement rate was computed at the final follow-up.As a result,all patients underwent successful surgery and were followed up for(11.6±4.7)months.The operation time was(43.0±5.3)min.Intraoperative blood loss(7.9±2.8)ml;Postoperative drainage volume(8.1±2.3)ml.The JOA score increased from 7.9±1.2 before surgery to 13.5±1.3 six months after surgery,and it was 13.7±1.2 at the last follow-up,the differences between postoperative and preoperative were both statistically significant(both P<0.001).No complications occurred,such as cerebrospinal fluid leakage,nerve injury and intraspinal hematoma.At the last follow-up,cervical spine X-ray or CT evaluation showed no instability in the operative segment.The overall curative effect was evaluated according to JOA score at the last follow-up:16 cases got excellent outcome,7 cases got good and 2 cases got medium outcome,with an excellent and good rate of 89.3%(25/28).This study shows that unilateral biportal endoscopic posterior total laminectomy decompression in the treatment of single-level cervical stenosis can achieve satisfactory efficacy,has no impact on spinal stability,and has a high safety.