颈后路全内镜下颈椎间盘切除术与颈前路颈椎间盘切除植骨融合术治疗颈椎间盘突出症的疗效对比

Comparison of the effect of posterior percutaneous full-endoscopic cervical discectomy and anterior cervical decompression and fusion for the patients with cervical intervertebral disc herniationand

目的比较颈后路全内镜下椎间盘切除术(PPECD)与颈前路颈椎间盘切除植骨融合术(ACDF)治疗单节段旁中央型颈椎间盘突出症的疗效和对邻近节段退变的影响。方法回顾性分析2016年1月至2018年1月期间在本院行手术治疗的88例单节段旁中央型颈椎间盘突出症患者病例资料。按照所行的手术方式分为PPECD组(n=42)及ACDF组(n=46)。比较两组患者的基线情况,手术前、后颈及上肢视觉疼痛评分(VAS),颈椎功能障碍指数(NDI),手术邻近节段左、右侧屈曲及前屈后伸测定值和颈椎相邻节段退变情况。结果两组患者术后随访时间均为12个月。末次随访时,两组患者颈及上肢VAS和NDI评分与术前相比均有改善(P<0.05),而两组间比较差异无统计学意义(P>0.05);PPECD组邻近节段左、右侧屈曲及前屈后伸测定值术前比差异无统计学意义(P>0.05),ACDF组较术前增大(P<0.05),并且大于PPECD组(P<0.05);PECD组颈椎邻近节段退变情况优于ACDF组(P<0.05)。结论PPECD和ACDF均能显著改善单节段旁中央型颈椎间盘突出症患者的临床症状,但PPECD对维持患者术后颈椎活动度、减少术后邻近椎体节段退变有一定优势。

Objective To compare the clinical efficacy of posterior percutaneous full-endoscopic cervical discectomy(PPECD) and anterior cervical decompression and fusion(ACDF) for single segment paramedian cervical intervertebral disc herniationand and its effects on postoperative adjacent segment degeneration. Methods Retrospective analysis of 88 patients with single segment paramedian cervical disc herniationand from January 2016 to January 2018 were divided into group PPECD(n=42) and group ACDF(n=46) according to the surgical procedure. The baseline situation, visual analog scale(VAS), neck disability index(NDI), the measurement of the flexion extension, left flexion and right flexion of adjacent segments and adjacent segment degeneration were compared between two groups. Results Two groups of patients were followed up for 12 months. At 12 months after surgery, the NDI, VAS of radicular arm pain and neck pain of both groups were significantly improved compared with preoperative(P<0.05), but there was no significant difference between the two groups(P>0.05). At 12 months after surgery, the measurement of the flexion extension, left flexion, and right flexion of adjacent segments of the PPECD group was no significant difference with preoperative(P>0.05). The ACDF group was increased compared with the preoperative(P<0.05) and higher than the PPECD group(P<0.05). At 12 months after surgery, ACDF group had a significantly severer adjacent segment degeneration compared with PPECD group(P<0.05). Conclusion Both PPECD and ACDF can significantly improve the clinical symptoms of patients with single segment paramedian cervical disc herniationand. However, PPECD has the advantages in maintaining the cervical movement and reducing the adjacent degeneration.