前路经皮内镜治疗神经根型颈椎病

Anterior percutaneous endoscopic nerve root decompression for cervical spondylotic radiculopathy

目的探讨前路经皮内镜下颈神经根减压术治疗神经根型颈椎病的可行性、安全性和疗效。方法选择2012年7月-2013年12月收治的11例经前路经皮内镜下颈神经根减压治疗的神经根型颈椎病患者，其中男6例，女5例；年龄27～63岁，平均42．1岁。累及部位：C3/4间隙1例，C4/5间隙2例，C5/6间隙6例，C6/7间隙2例。所有患者非手术治疗6周效果不佳。统计手术时间、术后并发症，记录术前及术后3d、1，3，6，12个月视觉模拟评分（VAS），术前及术后3，12个月改良Macnab评分。结果本组手术时间（102．5±21．3）min（80—140min）。9例患者获得12个月随访，无并发症发生。术后3d、1，3，6，12个月VAS较术前明显改善（P〈0．01）；术后3，12个月改良Macnab评分较术前明显改善（P〈0．01）。结论颈前椎间盘入路经皮内镜下颈神经根减压术治疗神经根型颈椎病安全可行且疗效肯定。

Objective To evaluate the feasibility, safety, and clinical outcome in patients with cervical spondylotic radiculopathy underwent cervical nerve root decompression using the anterior percutaneous endoscopic surgery. Methods Eleven subjects consisting of 6 men and 5 women treated from July 2012 to December 2013 were enrolled in the study. Mean age was 42.1 years （range, 27 to 63 years）. All were diagnosed to be unilateral single-segment injury involving C3/4 in 1 case, C4/5 in 2 cases, C5/s in 6 cases and C6/7 in 2 cases. Because of unsatisfactory results 6 week following the non- operative treatment, the patients were operated on using the anterior percutaneous endoscopic osteophyte removal and nerve root decompression. Operation time, postoperative complications, visual analogue scale （VAS） and modified Macnab scale were recorded. Results Operation time was （ 102.5 ± 21.3 ） min （range, 80-140 min）. Nine patients were followed up for 12 months and no complications were noted. VAS improved significantly at postoperative 3 days and 1, 3, 6, as well as 12 months compared to the preoperative value （P 〈 0.01 ）. Modified Macnab scale presented great improvement at postoperative 3 and 12 months compared to the preoperative value （ P 〈 0. 01 ）. Conclusion The technique is reliable and effective in treatment of cervical spondylotic radiculopathy.