经皮穿刺颈椎髓核成形术治疗多间隙颈椎间盘突出症

Percutaneous cervical nucleoplasty on the treatment of multiple cervical disc herniation

目的:探讨经皮穿刺颈椎髓核成形术(percutaneous cervical nucleoplasty,PCN)治疗多间隙颈椎间盘突出症的临床疗效及其对颈椎稳定性的影响。方法:对我院2003年7月～2005年6月因颈椎间盘突出症住院行PCN治疗的64例患者进行回顾性研究,根据手术间隙分为两组:单间隙组(A组)34例,多间隙组(B组)30例。临床效果评价采用JOA评分标准(17分制并计算改善率),颈椎稳定性评价采用Katsumi标准。比较两组的临床效果及颈椎稳定性。结果:随访6～24个月,A组平均14.1±3.7个月,B组平均13.9±3.8个月,A组术前JOA评分为9.19±2.64分,术后为14.37±1.42分,改善率为66.3%;B组术前JOA评分为8.89±2.31分,术后为14.33±1.28分,改善率为67.1%,与术前比较均有显著性差异(P<0.001),两组患者的JOA评分改善率无显著性差异(P>0.05)。两组患者术后颈椎稳定性与术前比较均无显著性差异(P>0.05)。结论:PCN治疗多间隙颈椎间盘突出症效果优良,对颈椎稳定性影响小,不会造成颈椎失稳。

Objective：To explore the therapeutic effect of percutaneous cervical nucleoplasty （PCN） on the treatment of the mulitiple cervical disc herniation and the mechanical effect on cervical spine stability. Method：A retrospective study of 64 cases with cervical disc herniation operated by PCN from July 2003 to June 2005 was performed.These cases were divided into two groups according to MRI findings：single-level cervical disc herniation group（group A） and multiple-level cervical disc herniation（group B）.The clinical outcome was evaluated by JOA scoring and cervical stablility was assessed by Katsumi standard.The clinical and the mechanical result of cervical spine after operation were evaluated and compared between two groups.Result：All cases were followed up for 6 months to 24 months, （averaging：14.06±3.72 months for group A, 13.93±3.83 months for group B）.All cases had been successfully operated.The JOA score was 9.19±2.64 of preoperation and 14.37±1.42 of postoperation in group A,which had good to excellent rate of 66.3%.In group B,the preoperational JOA was 8.89±2.31 and 14.33±1.28 for postoperation,with the good to excellent rate of 67.1%.There was a significant difference in the pre- and post-operation scores of each group （P〈0.001）,but no significant difference with respect to the clinical outcomes （P〉0.05） was noted.No cases in two groups showed any evidence of cervical spine instability after operation,and no significant difference in either pre or postoperation between 2 groups was noted too （P〉0.05）.Conelusion：PCN treatment of multiple cervical disc herniation has good outcomes without any effect on the stability of cervical spine.