摘要
目的探讨后路显微内镜颈椎髓核摘除术(cervical microendoscopic discectomy,CMED)治疗单节段神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的临床疗效。方法 2010年9月至2013年3月,我科采用后路CMED治疗单节段CSR患者19例,18例获随访,其中男13例,女5例;年龄31~59岁,平均41.9岁;病变节段C(4~5) 5例,C(5~6) 9例,C6-7 4例;均表现为单侧神经根卡压节段性根性疼痛,颈椎动力位X线片未见颈椎不稳。首次随访时间6~25个月,平均12.7个月,末次随访28~51个月,平均32.5个月,随访观察患者的视觉模拟评分(visual analogue scale,VAS)、日本骨科学会(Japanese orthopaedic association,JOA)评分、颈椎病变节段稳定性和椎间高度的变化,并进行统计学分析。结果 VAS评分由术前的(7.12±1.11)分降至出院时的(2.82±0.64)分,首次和末次随访时分别为(1.94±0.76)分和(2.00±0.51)分;JOA评分由术前(12.58±1.06)分提高至出院时的(15.63±0.51)分,首次和末次随访时分别是(16.12±0.72)分和(15.88±0.78)分;出院时、首次随访和末次随访与术前相比,差异均有统计学意义(P〈0.05);术前病变节段的椎间高度为(5.55±0.52)mm,末次随访时为(5.39±0.51)mm,虽有所减少,但差异无统计学意义(P〉0.05);过伸过屈位X线片未显示明显颈椎失稳。结论只要选择好合适的适应证,后路CMED治疗单节段CSR创伤小、并发症少,能够获得满意的短中期临床疗效,但远期疗效仍有待继续观察。
Objective To describe the outcome of cervical microendoscopic discectomy ( CMED ) for monosegmental cervical spondylotic radiculopathy ( CSR ). Methods A retrospective study was conducted on 19 patients with cervical spondylotic radiculopathy who underwent microendoscopic discectomy from September 2010 to March 2013, and 18 patients were followed up for 12.7 months ( range: 6 - 25 months ) at the first and 32.5 months ( range: 28 - 51 months ) at the end. There were 13 males and 5 females with an average age of 41.9 years ( range: 31 - 59 years ). The level of herniation was C4.5 in 4 cases, C5.6 in 9 cases and C6.7 in 4 cases. All patients had clinical presentations and findings on neurological examinations consistent with unilateral herniated nucleus pulposus at singlelevel, while no dynamic instability were found in cervical hyperextension and hyperflexion on X-ray. Clinical efficacy were evaluated by VAS score, JOA score, the stability and intervertebral height in lesion segment. Results VAS decreased from ( 7.12 ± 1.11 ) points preoperatively to ( 2.82 ±0.64 ) points at discharge, to ( 1.94 ± 0.76 ) points at the first follow-up and to ( 2.00 ± 0.51 ) points at the final follow-up. JOA scores increased from ( 12.58± 1.06 ) points preoperatively to ( 15.63 ± 0.51 ) points at discharge, to ( 16.12 ± 0.72 ) points at the first follow-up and ( 15.88 ±0.78 ) points at the final follow-up. The preoperative VAS and JOA scores showed significant difference ( P 〈 0.05 ) as compared with those of each postoperative time point. Intervertebral height at surgical level of preoperative and at the final follow-up was ( 5.55±0.52 )mm and ( 5.39 ± 0.51 ) mm respectively, which were not significantly different. ( P 〉 0.05 ). No radiographic instability was revealed on dynamic radiographs. Conclusions With proper patient selection, posterior CEMD is safe and effective in treatment of single-level CSR with the advantage of minimal invasion and quick recovery, while its long-term outcomes require further follow-up.
出处
《中国骨与关节杂志》
CAS
2016年第5期339-343,共5页
Chinese Journal of Bone and Joint
关键词
外科手术
微创性
内窥镜
椎间盘切除术
颈椎
神经根病
椎间盘移位
Surgical procedures, minimally invasive
Endoscopes
Diskectomy
Cervical vertebrae
Radiculopathy
Intervertebral disc displacement