高速磨钻在颈前路手术中的应用研究

Clinical Efficacy Evaluation of Treatment of Cervical Spondylosis with High-speed Drills

目的分析高速磨钻下颈前路手术治疗神经根型颈椎病的疗效。方法回顾性分析我科2012年9月-2014年12月通过颈椎前路手术治疗的22例神经根型颈椎病合并椎体后缘骨赘增生的患者的相关资料。所有患者均采用显微镜下经颈前路间盘切除植骨融合钛板内固定术(ACDF)配合使用高速磨钻切除椎体后缘增生的骨赘。分别记录手术时间,出血量,术前以及术后1周、2月的VAS评分,颈椎神经功能JOA评分,以及术后出现声音嘶哑、吞咽不适、脑脊液漏,食管瘘的发生率。结果手术时间55~111 min,平均76±23 min;术中出血约35~80 ml,平均50±14 ml。所有患者均随访1~2年,平均1.1±0.3年。所有患者上肢疼痛VAS评分明显降低,JOA评分明显改善,与术前比较差异有统计学意义(P<0.05)。7例患者出现吞咽不适,经过对症治疗后症状消失。未出现脑脊液漏和食管瘘的病例。结论使用高速磨钻在颈前路手术治疗椎体后缘骨赘增生所致神经根型颈椎病出血量少,能完整切除骨赘,消除神经受压因素,手术疗效好。在显微镜下操作能够更好地观察手术视野,减少脊髓损伤、脑脊液漏等手术并发症的发生。

Objective To evaluate the clinical efficacy of treating cervical spondylotic radiculopathy with high-speed drills.Methods The clinical data of 22 patients of cervical spondylosis radiculopathy(CSR)combined with vertebral posterior margin osteophyte hyperplasia who had been treated with anterior cervical discectomy with fusion(ACDF)under a microscope and with high-speed drills was retrospectively analyzed.The duration of surgery,blood loss,preoperative VAS score and JOA score and those 1 week,2 months postoperatively,and the incidence of hoarseness of voice,swallowing discomfort,cerebrospinal fluid leakage and esophageal fistula were recorded separately.Results The duration of surgery ranged from 55 to 111 min,76±23 minutes on average.Intraoperative bleeding ranged from 35 to 80 ml,an average of 50±14 ml.All the patients were followed up for 1 or 2 years,1.1±0.3 years on average.After surgery,the VAS scores of upper limb pain of all the patients were significantly decreased,while the JOA scores improved significantly,and the difference was statistically significant.Among these patients,7 cases showed swallowing discomfort,and the symptoms disappeared after symptomatic treatment.No cases of cerebrospinal fluid leakage and esophageal fistula occurred.Conclusion There is relatively little blood loss in the course of treating CSR caused by vertebral posterior osteophyte proliferation under a microscope using high-speed grinding drills.This approach can completely excise osteophytes and eliminate nerve compression factors.The curative effect is good.Operating under a microscope can help observe the surgical field better and reduce surgical complications,such as spinal cord injury or cerebrospinal fluid leakage.