低温等离子射频消融术治疗颈椎间盘突出症合并脊髓缺血老年患者的效果

Efficacy of low-temperature plasma radiofrequency ablation in treating cervical disc herniation complicated with spinal cord ischemia in elderly patients

目的评价低温等离子射频消融术治疗颈椎间盘突出症合并脊髓缺血老年患者的临床疗效。方法颈椎间盘突出症患者20例,年龄65~79岁,体重51~89 kg,ASA分级Ⅰ或Ⅱ级,按照是否合并脊髓缺血分为2组(n=10):颈椎间盘突出症组(C组)和颈椎间盘突出症合并脊髓缺血组(C+I组)。在C型臂下2组行颈椎间盘低温等离子射频消融术。记录术中神经损伤和血管损伤等不良反应的发生情况。分别于术前1 d和术后3 d、1、3、6、12个月时采用视觉模拟评分法(VAS)评价疼痛程度;分别于术前1d和术后12个月时采用颈椎功能障碍指数(NDI)评定颈椎功能情况;术后12个月时采用Macnab分级评价疗效。结果2组患者术中未见神经损伤和血管损伤等不良反应的发生。与术前1 d时比较,2组术后各时点VAS评分降低,术后12个月时NDI降低(P<0.05);与C组比较,C+I组术后3 d和1个月时VAS评分升高(P<0.05),术后3、6、12个月时VAS评分、术后12个月时NDI和Macnab分级差异无统计学意义(P>0.05)。结论低温等离子射频消融术可安全有效地用于颈椎间盘突出症合并脊髓缺血的老年患者。

Objective To evaluate the efficacy of low-temperature plasma radiofrequency ablation in treating cervical disc herniation complicated with spinal cord ischemia in elderly patients.Methods Twenty patients with cervical disc herniation,aged 65-79 yr,weighing 51-89 kg,of American Society of Anesthesiologists physical statusⅠorⅡ,were divided into 2 groups(n=10 each)according to whether patients had spinal cord ischemia:cervical disc herniation group(C group)and cervical disc herniation combined with spinal cord ischemia group(C+I group).Low-temperature plasma radio-frequency ablation were performed through mobile C-arm X-ray in two groups.The occurrence of adverse reactions such as intraoperative nerve injury and vascular injury was recorded.Pain was assessed using visual analogue scale(VAS)score at 1 day before surgery and 3 days and 1,3,6 and 12 months after surgery.Cervical function was assessed by using the Neck Dysfunction Index(NDI)at 1 day before surgery and 12 months after surgery.The therapeutic effect was evaluated using modified Macnab criteria at 12 months after surgery.Results No intraoperative nerve injury or vascular injury was observed in neither group.Compared with the baseline at 1 day before surgery,VAS scores were significantly decreased at each time point after surgery,and NDI was decreased at 12 months after surgery in two groups(P<0.05).Compared with group C,VAS scores were significantly increased at 3 days and 1 month after surgery(P<0.05),and no significant change was found in VAS scores at 3,6 and 12 months after surgery,NDI at 12 months after surgery or Macnab outcome grade in group C+I(P>0.05).Conclusion Low-temperature plasma radio-frequency ablation can be safely and effectively used in the elderly patients with cervical disc herniation complicated with spinal cord ischemia.