经皮颈椎后路内窥镜下颈椎间盘切除术传统减压与精准减压治疗神经根型颈椎病初期的疗效对比

Comparison of primary clinical efficacy of traditional decompression with precise decompression in the treatment of cervicalspondylotic radiculopathy in posterior percutaneous endoscopic cervical discectomy

目的对比分析经皮颈椎后路内窥镜下颈椎间盘切除术(Posterior Percutaneous Endoscopic Cervical Discectomy,PPECD)传统减压与3D-CT精准减压治疗神经根型颈椎病的初期疗效。方法纳入行PPECD治疗的39例神经根型颈椎病患者,分为A、B两组,A组23例患者行精准减压,B组16例患者行传统减压。对比分析A、B两组患者手术时间、术中出血量、术中透视次数、骨窗磨削最长径、视觉模拟评分(visual analoguescale,VAS)、日本矫形外科学会评分(Japanese Orthopaedic Association,JOA)及术后1年JOA改善率。结果 A、B两组患者术后均获得满意临床疗效。A、B两组手术时间、术中出血量、术中透视次数、骨窗磨削最长径等围手术期参数,差异均具有统计学意义。组内比较,两组患者术后VAS评分、JOA评分较术前均有明显改善。组间比较,术后1、3及6月A组患者VAS评分与JOA评分较B组,差异有统计学意义;术后3天及12月,两组VAS与JOA评分差异无统计学意义。结论 PPECD两种术式均可获得满意的初期疗效。但与传统减压相比,精准减压既保证疗效,又能有效减少术中透视次数,缩小骨窗磨削范围,降低术中出血量,缩短手术时间,提高手术安全性。

Objective To compare of primary clinical efficacy of traditional decompression with precise decompression in the treatment of cervicalspondylotic radiculopathy in PPECD.Methods 39 cases of cervicalspondylotic radiculopathy of PPECD surgery were selected and divided into two groups,group A 23 cases of patients with precise decompression,group B16 cases of patients with conventional decompression.The peration time,intraoperative blood loss,intraoperative fluoroscopy,grinding bone window size,visual analogue scale（VAS）,the Japanese Orthopaedic Association score（JOA）and the improvement rate of JOA of two groups were compared.Results Two groups of patients could obtain satisfactory clinical efficacy after operation.The perioperative parameters such as operation time,intraoperative blood loss,intraoperative fluoroscopy times,and maximum length of bone window grinding were significantly different between the two groups of A and B.The VAS score and JOA score of the two groups were significantly improved after operation compared with those before operation.Between group comparison,after 1,3,6 month,the A score and JOA score in group VAS are significantly better than those in group B;after 3 days and 12 month,there was no significant difference in VAS and JOA scores between the two groups.Conclusion Satisfactory clinical efficacy can be obtained by two PPECD methods.Compared with the traditional decompression,the precise decompression can effectively reduce the fluoroscopy times and narrow the grinding range of the bone window,reduce the amount of bleeding during operation,shorten the operation time and improve the safety of operation.