后路经皮内镜下颈椎间盘切除术治疗神经根型颈椎病的短期疗效观察

Short-term clinical efficacy of posterior percutaneous endoscopic cervical discectomy in treatment of cervical spondylotic radiculopathy

目的观察后路经皮椎间孔镜下颈椎间盘髓核摘除术治疗颈椎间盘突出症的安全性及短期临床疗效。方法采用经皮后路椎间孔镜技术治疗16例患者,评价并比较患者术前、术后1周、术后1、3、6个月的疼痛视觉模拟评分(visual analogue scale,VAS)及日本骨科协会评估治疗评分(Japanese Othopaedic Association Scores,JOA),末次随访采用改良MacNab标准评价临床疗效。结果本组患者的手术时间55~90min,术中出血量10~25mL,住院时间4~7d。13例均获得随访,时间6个月。无神经根损伤、硬膜囊破裂、脊髓或血管损伤等并发症发生。术后各时段VAS评分及JOA均较术前明显改善,差异均有统计学意义(P<0.05)。术后6个月根据改良MacNab标准评定疗效:优10例,良5例,可1例,总体优良率93.75%。结论在严格选择适应症的前提下,后路经皮椎间孔镜下颈椎间盘髓核摘除术治疗神经根型颈椎病是一种安全、有效的微创手术方式,近期疗效可靠。

Objective To observe the safety and short-term clinical curative effect of posterior percutaneous endoscopic cervical discectomy(PECD)in treatment of cervical spondylotic radiculopathy(CSR).Methods Totally 16 CSR patients were treated with posterior PECD.Visual analogue scale(VAS)scores and Japanese Othopaedic Association(JOA)scores were assessed before operation and at week 1,month 1,3 and 6 after operation.In addition,the clinical therapeutic effect was evaluated by the modified MacNab standard at the last follow-up.Results The operation length was 55-90 min,blood loss was 10-25 mL,and hospital stay was 4-7 days.We followed up 13 patients for 6 months.We did not find any severe complications such as neurological injury,dural sac rupture,spinal cord or vascular injury.VAS scores and JOA scores were significantly improved as compared with those before operation(P<0.05).In terms of the modified MacNab at postoperative 6 month,10 cases obtained excellent outcome,5 good,and 1 fair with the effective rate being 93.75%.Conclusion Based on strict selection of surgery indications,it is a safe and effective minimally invasive surgery to treat CSR with posterior PECD.Meanwhile the short-term curative effect is reliable.