显微镜与带头灯的放大镜辅助下前路颈椎间孔切开减压术的疗效比较

Comparation between microscope and surgical telescopes assisted procedure for anterior cervical foraminotomy: results of a randomized controlled study

目的 比较显微镜与带头灯的放大镜辅助下前路单节段颈椎间孔切开减压术的疗效.方法 2008年6月至2012年2月,85例需行前路单节段颈椎间孔切开减压术患者被随机分为两组（44例和41例）,分别在显微镜或者带头灯的放大镜辅助下施术.比较两组手术病例的平均手术切口长度、手术时间、出血量、并发症、出院天数、住院费用及手术前后日本骨科协会（JOA）评分及改善率,评估两种手术方法的差异.结果 75例患者获得门诊或电话随访,随访12.52 ～40.16个月,平均（31.27±11.62）个月,随访率88.23％.两组患者术前临床资料均无统计学差异,包括年龄、性别、病变节段和术前JOA评分.术后JOA评分及改善率、住院天数、住院费用、随访时间等方面比较差异均无统计学意义；在手术切口长度、手术时间、术中出血量、复发率、随访JOA评分及改善率方面比较差异均有统计学意义（P＜0.05）.结论 显微镜与带头灯的放大镜辅助下前路颈椎间孔切开减压术均可获得满意的近期疗效,且显微镜辅助下前路颈椎间孔切开减压术精准性更高,更符合微创功能脊柱外科的治疗理念.

Objective To compare the clinical outcomes of anterior cervical foraminotomy assisted with microscope or surgical telescopes.Methods From June 2008 to February 2012,85 patients with single segment cervical foraminotomy were randomly divided into two groups assisted with microscope or surgical telescopes.Comparation would be made in terms of the length of skin incision,the operation time,amount of bleeding,incidence of complication,duration of hospitalization,hospitalization cost,Japanese Orthopeadic Association （JOA） score,JOA recovery rate.Results Seventy-five patients received outpatient or telephone follow-up.The follow-up period was 12.52 to 40.16 months with an average of （31.27 ± 11.62） months,and the follow-up rate was 88.23%.According to preoperative data,the two groups didn＇t differ with respect to age,gender,level of radiculopathy,or preoperative JOA score and JOA recovery rate.No statistically significant differences were identified in postoperative JOA score and JOA recovery rate,duration of hospitalization,hospitalization cost,length of follow-up.Statistically significant differences were identified in skin incision,the operation time,amount of bleeding,incidence of complication,and follow-up JOA,JOA recovery rate and recurrent rate（P 〈 0.05）.Conclusion The clinical effect of both minimally invasive methods are satisfactory in short term.Higher accuracy has been acquired by microscopic cervical foraminotomy,which is more suitable for the minimally invasive concept of functional spine surgery.