显微内镜颈椎前路手术和开放手术的比较研究

Comparative study on anterior cervical surgery by microendoscopic and open operation

[目的]比较显微内镜颈椎前路手术和标准开放手术，探讨显微内镜颈椎前路减压植骨融合内固定术的可行性和有效性，初步评价其临床价值。[方法]对46例单节段颈椎前路手术患者进行回顾性比较研究。23例接受显微内镜颈椎前路手术，平均年龄41.5岁（23～64岁）。在全麻下取右侧颈前外横切口（长1．6cm），依次使用扩张管，通过工作通道插入内镜，在镜下切除颈椎间盘，扩大椎间隙。颈椎骨折脱位者采用前路钢板固定5例，CBK颈椎Cage固定1例，螺纹状钛合金Cage固定1例。颈椎间盘突出症者采用前路钢板固定2例，CBK颈椎Cage固定12例，螺纹状钛合金Cage固定2例。同期23例经开放手术，平均年龄46．5岁（25～68岁）。开放手术采用右侧颈前横切口（长4～5cm），切除颈椎间盘和扩大椎间隙，分别使用前路钢板和Cage固定。[结果]显微内镜手术组平均随访16．5个月（10～22个月），平均手术时间110min，失血40ml。采用Frankel分级标准：2例全瘫患者术后无改善，2例由C级恢复为D级，1例由C级恢复到E级。颈椎间盘突出症患者采用Odom评定标准：优10例、良5例、可1例。开放手术组平均随访15．2个月（8～21个月），平均手术时间95min，失血90ml。采用Frankel分级标准：2例全瘫患者术后无改善，3例由C级恢复为D级，1例由D级恢复到E级。颈椎间盘突出症患者采用Odom评定标准：优8例、良6例、可2例。[结论]同标准开放手术比较，椎间盘镜手术设备和技术可以用于单节段颈椎前路减压植骨融合内固定手术，并取得相似的短期临床治疗效果。

[ Objective ] To complete comparison between anterior cervical surgery by microendoscopic and open operation, explore feasibility and efficacy, of anterior cervical decompression, interbody fusion and fixation by microendoscopic surgery, and give preliminary clinical evaluation of mieroendoscopic surgery. [ Method] In a retrospective study, 46 patients underwent one level cervical surgery by anterior approach. 23 patients （23 - 64 years, 41.5 years in average） were treated with microendoscopic surgery as microendoscopic group. Under general anesthesia, a transverse incision （ 1.6 cm） was made at right side of neck. A tubular retractor was then inserted and fixed, and a specially designed endoscope was placed inside the tubular retractor. Discectomy and interbody fusion with insertion of Cage or/and plate fixation was performed by endoscope. At fracture and dislocation patient group, titanium Cage was used in 1 case, CBK in 1 case, plate in 5 cases. At cervical disc herniation patient group, titanium Cage was used in 2 cases, CBK in 12 cases, plate in 2 cases. During the same period, 23 patients （25 -68 years, 46. 5 years in average） were treated with open surgery as open group. A transverse incision （4 -5 cm） was made by right route approach. Discectomy and interbody fusion with Cage or/and plate fixation was performed by general procedure. [ Result] At microendoscopic group, 23 cases were followed up from 10 to 22 months （ 16. 5 months in average） , and mean operative time were 95 minutes, mean blood loss 90 ml. For fracture and dislocation patients, by Frankel＇s classification, 2 cases with complete tetraplegia showed no improvement, 2 cases with incomplete tetraplegia improved from grade C to grade D postoperatively, 1 case upgraded from C to E. For cervical spondylotic myelopathy patients with disc herniation, according to Odom＇s scoring system, 10 cases had excellent outcome, 5 good, 1 fair. At open group, 23 cases were followed up from 8 - 21 months （ 15.2 months as average）, and mean operative time was 95 minutes, mean blood loss 90 ml. By Frankel＇s classification, 2 cases with complete tetraplegia had no improvement, 3 cases with incomplete tetraplegia improved from C to D, I case from D to E. According to Odom＇s scoring syste, 8 patients suffering from cervieal spondylotic myelopathy with dise hemiation had excellent result. 6 good, 2 fair. [Conclusion ] Compared with open surgery, microendoseopic surgery with endoscopic instrument and technique can be used for one level disceetomy, interbody fusion and internal fixation, and offer a similar short-tern good clinical outcome with minimal incision, less traumatic reaction and postoperative discomforl.