多模式神经电生理辅助下经皮内镜下颈椎间盘切除术的早期疗效观察

Early efficacy of percutaneous endoscopic cervical discectomy with multimodal neurophysiological monitoring

目的探讨神经电生理监测(NM)辅助下经皮内镜下颈椎间盘切除术(PECD)治疗神经根型颈椎病(CSR)的临床疗效。方法回顾性分析2015年4月至2018年5月河南省人民医院脊柱外科收治的55例CSR患者临床资料,其中29例应用多模式NM辅助下PECD治疗(NM组),26例单纯应用PECD治疗(PECD组)。记录并比较两组患者性别、年龄、手术时间、出血量、平均住院日、并发症以及术前、术后1个月与末次随访时颈部和上肢疼痛视觉模拟评分(VAS)、日本矫形外科协会(JOA)评分等指标。组间数据比较采用独立样本t检验。结果两组所有患者均获得至少18个月的随访。术后1个月NM组和PECD组颈部疼痛VAS分别为(2.1±1.2)、(2.0±1.1)分,上肢VAS分别为(2.4±1.2)、(2.2±0.8)分;末次随访时两组颈部VAS分别为(0.8±0.5)、(0.7±0.5)分,上肢VAS分别为(0.8±0.7)、(0.8±0.5)分,均较术前[颈部:(6.0±1.0)、(5.9±1.0)分,上肢:(7.1±0.9)、(7.4±0.9)分]明显降低(t=12.670~27.305,均P<0.05),但组间比较差异均无统计学意义(t=-1.107~0.917,均P>0.05)。术后1个月NM组和PECD组JOA评分分别为(12.7±0.8)分、(12.6±0.8)分,末次随访时分别为(14.6±0.7)分、(14.4±0.8)分,均较术前[(11.1±1.0)分、(10.9±0.8)分]明显升高(t=-11.074、-14.829、-9.603、-13.086,均P<0.05),组间比较差异均无统计学意义(t=0.842、0.003,均P>0.05)。NM组出血量、手术时间与PECD组差异均无统计学意义(t=-0.615、-0.922,均P>0.05),但住院时间、并发症均显著减少(t=-2.815,χ^2=4.755,均P<0.05)。结论多模式NM辅助下PECD治疗CSR获得满意疗效的同时可降低平均住院日、减少并发症,提高手术安全性。

Objective To explore the clinical efficacy of percutaneous endoscopic cervical discectomy(PECD)assisted by neurophysiology monitoring(NM)in the treatment of cervical spondylotic radiculopathy(CSR).Methods The clinical data of 55 patients with CSR treated in the Department of Spinal Surgery of Henan Provincial People′s Hospital from April 2015 to May 2018 were analyzed retrospectively.Among them,29 patients were treated with multi-mode NM-assisted PECD(NM group)and 26 patients with PECD alone(PECD group).The gender,age,operation time,bleeding volume,average hospital stay and complications between the two groups were recorded and compared.In addition,the visual analogue score(VAS)of neck and upper limb pain and the score of Japanese Orthopedic Association(JOA)were compared between the two groups before operation,1 month after the operation and at the last follow-up.These data between groups were compared by independent sample t test.Results All patients in both groups were followed-up for at least 18 months.Neck VAS and upper limb VAS scores of two groups at 1 month post operation(neck:2.1±1.2,2.0±1.1;upper lamb:2.4±1.2,2.2±0.8)and the last follow-up(neck:0.8±0.5,0.7±0.5;upper lamb:0.8±0.7,0.8±0.5)decreased significantly when compared with those before the operation(neck:6.0±1.0,5.9±1.0;upper lamb:7.1±0.9,7.4±0.9)(t=12.670-27.305,all P<0.05).However,there was no significant difference between the two groups(t=-1.107-0.917,all P>0.05).JOA scores of two groups at 1 month after the operation(12.7±0.8,12.6±0.8),and at the last follow-up(14.6±0.7,14.4±0.8)were all improved significantly from those before the operation(11.1±1.0,10.9±0.8)(t=-11.074,-14.829,-9.603,-13.086,all P<0.05);however,there was no significant difference between the two groups(t=0.842,0.003,both P>0.05).There was also no significant difference in bleeding volume,and operation time between the two groups,(t=-0.615,-0.922,P>0.05)but the average hospital stay and incidence of complications in the NM group were significantly lower than those in the PECD group(t=-2.815,χ^2=4.755,both P<0.05).Conclusion Multimode NM-assisted PECD in the treatment of CSR achieves satisfactory results,reducing the average hospital stay,reducing complications and improving surgical safety.