经皮穿刺髓核切除术治疗退变性颈椎间盘突出症

Treatment of degenerative cervical disc herniation by percutaneous cervical discectomy

目的:探讨经皮穿刺颈椎髓核切除术(percutaneouscervicaldiscectomy,PCD)治疗不同退变程度颈椎间盘突出症的临床疗效及对颈椎稳定性的影响。方法:对我院2000年1月￣2003年12月因退变性颈椎间盘突出症住院行PCD治疗的64例患者进行回顾性分析,椎间盘退变的程度根据MRI分为中度组(mediandegenera-tiongroup,MDG)与重度组(severedegenerationgroup,SDG),对两组手术时间、临床效果及术后颈椎稳定性等方面进行比较。结果:所有病例随访12￣40个月,两组手术均成功。MDG手术时间为13.72±1.46min,SDG为16.97±2.01min,两组间有显著性差异(P<0.01);两组术后JOA评分均显著增高,与术前比较有显著性差异(P<0.01);临床效果(Williams评价)MDG优于SDG,有显著性差异(P<0.05)。两组手术后均无颈椎不稳病例发生,各手术间隙的椎体角度位移(angulardisplacement,AD)及椎体水平位移(horizontaldisplacement,HD)手术前后均无显著性差异(P>0.05)。结论:PCD适用于不同退变程度的颈椎间盘突出症,及时手术临床疗效好;PCD对颈椎稳定性影响小,不会造成颈椎失稳的发生。

Objective：To discuss the therapeutic outcome of pereutaneous cervical diseeetomy（PCD） on the treatment of the degenerative cervical disc herniation and it＇s impaet on the cervical spinal stability.Method： A retrospective study of 64 cases with degenerative cervical disc herniation operated with PCD from January 2000 to December 2003 were reviewed.Based on the demonstration of MRI,these eases were divided into median degenerative group（MDG） and severe degenerative group（SDG）.The time of operation,clinical outcome and the stability of cervical spine after operation were evaluated and compared between two groups.Result：All eases were followed up for 12 months to 40 months.All cases were successfully operated,The operation time for MI）G was （13.72±1.46）min,SDG （16.97±2.01）rain,and there was significant difference between two groups （P〈0.01）.There was significant difference in the pre-and post-operation JOA scores of each group（P〈0.01 ）. For the Williams score,the MDG clinical outcome outscored the SDG,which had significant difference（P〈 0.05）.No instability of cervical spine,no angular or horizontal displacement postoperatinn was observed in each group（P〉0.05）.Conclusion：Treatment of degenerative cervical disc herniation with PCD has good outcomes and no effect on the stability of cervical spine.PCD is a safe,minimally invasive operation with less traum and excellent clinical outcome.