显微内镜下颈椎后路椎间孔切开减压术的疗效探讨

EFFICACY OF POSTERIOR MICROENDOSCOPIC FORAMINOTOMY FOR CERVICAL RADICULOPATHY

目的探讨显微内镜下颈椎后路椎间孔切开减压术治疗神经根型颈椎病及颈椎间盘突出症的临床疗效。方法2004年2月-2007年6月,于显微内镜下行颈椎后路椎间孔切开减压术24例。男16例,女8例;年龄42～68岁,平均59岁。其中神经根型颈椎病16例,颈椎间盘突出症8例。病变节段:C4、58例,C5、612例,C6、74例。病程6～15个月。影像学检查显示8例颈椎间盘突出症中软性突出物6例、硬性突出物2例;神经根型颈椎病的受压因素主要为黄韧带肥厚、钩椎关节增生及关节突关节位置异常。根据日本骨科协会(JOA)脊髓功能评分法评定为(12.60±1.52)分。结果手术时间90～120min,平均100min;术中出血量100～150mL,平均120mL。1例全麻手术患者术中为切除钙化的突出髓核组织造成神经根牵拉伤,术后采用甲泼尼龙冲击治疗后3个月神经根功能恢复;其余患者术后神经根疼痛症状明显改善19例,减轻4例。术后影像学检查显示手术部位减压彻底。24例均获随访,随访时间24～36个月,平均28个月。X线片及CT检查示椎间高度无明显丢失,生理曲度正常。术后24个月根据JOA脊髓功能评分法评定为(16.10±0.29)分,与术前比较差异有统计学意义(P<0.01)。结论显微内镜下颈椎后路椎间孔切开减压术可通过小切口快捷进入术区,减少了组织损伤,避免了椎间高度丢失,临床疗效优良。

Objective To evaluate the clinical results of posterior microendoscopic foraminotomy in the treament of cervical radiculopathy and cervical intervertebral disc protrusion. Methods From February 2004 to June 2007,24 cases of cervical radiculopathy received posterior microendoscopic foraminotomy. There were 16 males and 8 females,aging 42-68 years （59 years on average）,including 16 cases of cervical radiculopathy and 8 cases of cervical intervertebral disc protrusion. The course of disease was 6-15 months. The affected intervertebral discs were C4,5 in 8 cases,C5,6 in 12 cases,and C6,7 in 4 cases. The radiological examinations showed that 8 protrusions included 6 soft tissue protusions and 2 rigid tissue protusions,and that cervical radiculopathy were caused by yellow ligament hypertrophy,Luschka＇s joint hyperplasia,and abnormal position of facet joint. According to Japanese Orthopedic Association （JOA）,the score before operation was （12.60 ± 1.52） points. Results The operation time was 90 to 120 minutes （100 minutes on average）,the bleeding during operation was 100 to 150 mL （120 mL on average）. Nerve root pain were relieved completely in 19 cases and were relieved partly in 4 cases. One case of calcifi ed nucleus pulposus had neurological traction injury and recovered completely after 3 months. All cases were followed up 24-36 months （28 months on average）. The radiological examinations after operation showed the intervertebral disc site was decompressed completely and the height of intervertebral disc and the cervical segmental alignment were normal. At 24 months postoperatively,the JOA score was （16.10 ± 0.29） points,showing significant difference when compared with that of preoperation （P 〈0.01）. Conclusion The posterior microendoscopic foraminotomy can get to the operation site with mini-incision,decrease tissue damage during operation,and avoid narrow intervertebral space,so it has satisfactory clinical results.