3种前路手术方式治疗单节段颈椎间盘突出症近期疗效比较

Comparison of short-term therapeutic effects of three methods of anterior surgery for single segment cervical disc herniation

目的比较经皮前路椎间孔镜下颈椎间盘髓核摘除术(APECD)、颈椎间盘置换术(CDR)、经颈前路椎间盘切除减压融合术(ACDF)治疗单节段颈椎间盘突出症的疗效。方法将46例单节段颈椎间盘突出症患者按手术方法分为APECD组(23例)、CDR组(10例)和ACDF组(13例)。记录3组手术时间、术中出血量,比较3组术后改善率、术后疼痛VAS评分与JOA评分。结果患者均获得随访,时间15~25(17±3)个月。手术时间:CDR组<ACDF组<APECD组,3组间两两比较差异有统计学意义(P<0.05);术中出血量:CDR组<APECD组<ACDF组,3组间两两比较差异有统计学意义(P<0.05)。末次随访时,3组VAS评分和JOA评分均较术前显著改善(P<0.05),3组间两两比较差异无统计学意义(P>0.05)。APECD组改善率为51.0%,CDR组改善率为43.2%,ACDF组改善率为64.5%,3组间两两比较差异无统计学意义(P>0.05)。结论3种前路手术方式治疗单节段颈椎间盘突出症均可取得满意的临床疗效,APECD手术创伤小,但术后有复发可能。

Objective To compare therapeutic effects of single segment cervical disc herniation treated with the anterior percutanous endomic cervical dissection(APECD),cervical disc replacement(CDR),anterior cervical disc fusion(ACDF).Methods Forty-six patients with single segment cervical disc herniation were divided into three groups according to the surgical method:APECD group(23 cases),CDR group(10 cases)and ACDF group(13 cases).The operation time,intraoperation bleeding volume,the improvement rate,VAS and JOA scores were recorded and compared.Results All patients were followed up for 15~25(17±3)months.Operation time:CDR group<ACDF group<APECD group,the difference between the two comparisons of the three groups was statistically significant(P<0.05);The intraoperative blood loss:CDR group<APECD group<ACDF group,the difference between the two comparisons of the three groups was statistically significant(P<0.05).At the last follow-up,the pain VAS and JOA score of the three groups were significantly improved compared with those before operation(P<0.05),and there was no significant difference among the three groups(P>0.05).The improvement rate:APECD group was 51.0%,CDR group was 43.2%,ACDF group was 64.5%,there was no significant difference among the three groups(P>0.05).Conclusions All three anterior approaches can achieve satisfactory clinical results in the treatment of single segment cervical disc herniation.APECD has less trauma,but it may relapse after operation.