经皮颈椎间盘髓核成形术与激光减压术治疗颈椎病的疗效比较

Comparision between percutaneous disc nucleoplasty and laser disc decompression for cervical spondylosis:the therapeutic effect and influence to vertebral stability

目的:比较经颈椎间盘髓核成形术(PCDN)与经皮颈椎间盘激光气化减压术(PLDD)治疗颈椎病的临床疗效及对颈椎稳定性的影响。方法:回顾性分析我院2005年1月￣2007年4月因颈椎病住院采用PCDN(72例)与PLDD(72例)治疗病例,比较两组在手术时间、临床效果及颈椎稳定性等方面的差异。临床效果评价采用JOA评分及Williams疗效标准,颈椎稳定性评价采用Katsumi标准。结果:两组手术均成功,手术时间PCDN组平均7.12±3.20min,PLDD组平均7.10±2.05min,两组间无显著性差异(P>0.05)。PLDD组1例患者术中发生终板损伤出血,术后出现颈部疼痛,对症处理后疼痛缓解。所有病例随访3￣28个月,PCDN组平均16.76±6.87个月,PLDD组平均17.23±7.40个月。JOA评分,PCDN组术前为9.37±0.98分,术后为14.52±0.78分;PLDD组术前为9.42±1.21分,术后为14.33±0.85分。两组JOA评分术后与术前比较均有显著性差异(P<0.01);两组之间无显著性差异(P>0.05)。Williams评估,PCDN组优42例,良21例,可7例,差2例;PLDD组优39例,良23例,可7例,差3例,两组间无显著性差异(P>0.05)。两组病例手术后均无颈椎不稳发生,颈椎稳定性手术前后均无显著性差异(P>0.05)。结论:经皮颈椎间盘髓核成形术与经皮椎间盘激光气化减压术治疗颈椎病的临床疗效优良,对颈椎稳定性影响小,不会造成颈椎失稳的发生。

Objective：To compare the therapeutic effect and influence to cervical vertebral stability of percutaneous cervical disc nucleoplasty（PCDN） and percutaneous laser cervical disc decompression（PLDD） for the treatment of cervical spondylosis.Method：A retrospective study was carried out for 144 patients of cervical spondylosis treated by either PCDN or PLDD from January 2005 to April 2007.They were divided into two groups：PCDN group in 72 cases and PLDD groups in 72 cases.The time of operation,the therapeutic effect and the stability of cervical spine after operation were evaluated and compared between two groups.JOA score and Williams standard were used for therapeutic evaluation,and Katsumi criteria for vertebral stability.Result： All cases had been successfully operated.Mean time of operation of PCDN was 7.12±3.20min,and PLDD was 7.10±2.05min.There was no significant difference in the operation time between tow groups （P〉0.05）.One patient from PCDN had end plate injury with bleeding,which resulted in postoperative neck pain but healed by symptomatic treatment.All cases were followed up from 3 months to 28 months,average 16.76±6.87 months for the PCDN group and 17.23±7.40 months for the PLDD group.JOA scores before and after operation were 9.37±0.98 and 14.52±0.78 for PCDN,and 9.42±1.21 and 14.33±0.85 for PLDD.There were significant differences in the pre- and post-operation scores of each group （P〈0.01）,however no singnificant difference between the two groups （P〉0.05）.Williams results of PCDN were excellent in 42 cases,good in 21 cases,fair in 7 cases and poor in 2 cases,results of PLDD were excellent in 39 cases,good in 23 cases,fair in 7 cases and poor in 3 cases,there was no significant difference between PCDN and PLDD（P〉0.05）.There was no case with instability of cervical vertebra in two groups after operation,and there was no significant difference of cervical vertebra stability in each group before and after operation （P〉0.05）.Conclusion：Both PCDN and PLDD for the treatment of cervical spondylosis are safe and effective,and show little influence to the stability of cervical spine.