经皮髓核成形术治疗退变性颈椎间盘突出症

Percutaneous nucleoplasty for degenerative cervical disc herniation

目的:探讨经皮髓核成形术治疗不同退变程度颈椎间盘突出症的临床疗效及颈椎稳定性的影响。方法:对我院2003年12月至2006年12月因退变性颈椎间盘突出症住院行经皮髓核成形术(PCN)治疗的88例患者进行回顾性分析,椎间盘退变程度根据MRI分为中度组(median degeneration group,MDG)与重度组(severe degeneration group,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6～30个月,两组手术均成功。MDG手术时间为(13.72±1.46)min,SDG为(16.97±2.01)min,两组间差异有显著性(P<0.01);两组术后JOA评分均显著增高,与术前比较差异有显著性(P<0.05);临床效果(Williams评价)MDG优于SDG,差异有显著性(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)及椎体水平位移(horizontaldisplacement)手术前后差异均无显著性(P>0.05)。结论:经皮髓核成形术对颈椎稳定性影响小,不会造成颈椎失稳的发生,适用于不同退变程度的颈椎间盘突出症。早期手术治疗可取得较好的临床疗效。

Objective To explore the efficay of percutaneous nucleoplasty for degenerative cervical disc herniation and its impact on the cervical spinal stability. Methods A retrospective analysis was conducted in 88 patients with degenerative cervical disc herniation who had undergone percutaneous nucleoplasty in our hospital from December 2003 to December 2006. These patients were divided into moderate-degeneration group （MDG） and severe-degeneration group （SDG） based on the degree of degeneration diagnosed by MRI. Duration of surgery, clinical efficacy, and the postoperative stability of the cervical spine were evaluated and compared between two groups. Results The procedure was successfully performed on all patients and they were followed for 6 to 30 months. Duration of surgery differed significantly between MDG and SDG [ （13.72 ± 1.46） min vs. （16.97± 2.01 ）min, P 〈 0.05]. The JOA scores of postoperation in both groups were markedly greater than those of preoperation （P 〈 0.01）. The efficacy of MDG was evidently superior to that of SDG according to Williams score （P 〈 0.05 ）. No instability of the cervical spine occurred. There was no significance between pre- and postoperation in angular or horizontal displacement （P 〉 0.05 ）. Conclusion Percutaneous nucleoplasty has little effect on the stability of cervical spine and which is suitable for degenerative cervical disc herniation.