颈后路经皮大通道全内镜椎板减压术治疗单节段脊髓型颈椎病的临床效果观察

Clinical study of posterior percutaneous large channel full-endoscopic cervical laminectomy and decompression in the treatment of single-segment cervical spondylotic myelopathy

目的探讨颈后路经皮大通道全内镜椎板减压术治疗单节段脊髓型颈椎病的临床效果。方法回顾性分析2017年2月—2019年3月河北医科大学第三医院脊柱外科、河北工程大学附属医院脊柱外科行后路经皮大通道全内镜椎板减压术治疗的17例单节段脊髓型颈椎病患者的临床资料,其中男11例、女6例,年龄42~81(57.1±8.7)岁。记录手术时间、手术出血量、住院时间及相关并发症。比较手术前后颈椎Cobb角、手术节段活动度(ROM)变化。采用颈椎功能障碍指数(NDI)和日本骨科协会(JOA)评分评价神经功能。末次随访时采用改良的MacNab标准评价临床疗效。结果17例患者均顺利完成手术,手术时间(71.1±10.1)min、手术出血量(76.9±16.4)mL、住院时间(6.3±1.7)d。术后均获随访12~18(13.7±1.9)个月。本组1例患者发生硬脑膜撕裂,余患者未发生脊髓损伤、重要血管损伤、脑脊液漏和伤口感染等并发症。术后1、3、12个月颈椎Cobb角分别为21.6°±4.2°、24.2°±4.1°、22.8°±3.8°,与术前的17.8°±3.9°比较有所增加,差异均有统计学意义(P值均<0.05);术后各时间点手术节段ROM与术前比较差异均无统计学意义(P值均>0.05);术后1、3、12个月NDI分别为16.8%±2.1%、14.3%±1.8%、12.3%±1.9%,与术前的32.4%±2.4%比较差异均有统计学意义(P值均<0.05),各时间点之间比较差异均有统计学意义(P值均<0.05);术后1、3、12个月JOA评分分别为(12.8±2.4)、(14.4±1.8)、(15.2±1.9)分,与术前的(8.6±2.2)分比较差异均有统计学意义(P值均<0.05),术后12个月与术后1个月比较差异有统计学意义(P<0.05)。末次随访时按照改良MacNab标准评价手术疗效,其中优9例、良6例、可2例,总体优良率15/17。结论后路经皮大通道全内镜椎板减压术治疗单节段脊髓型颈椎病是一种安全、有效的治疗方法,具有手术视野大、创伤小、术后恢复快等优点,可获得良好的临床疗效,但须严格把握手术适应证。

Objective To investigate the clinical effect of posterior percutaneous large channel full-endoscopic cervical laminectomy and decompression in the treatment of single-segment cervical spondylotic myelopathy(CSM).Methods The clinical data of 17 patients with single segmental CSM treated with posterior percutaneous large channel full-endoscopic cervical laminectomy and decompression at the Department of Spinal Surgery in the Third Hospital of Hebei Medical University and the Affiliated Hospital of Hebei Engineering University from February 2017 to March 2019 were analyzed retrospectively.A total of 11 males and nine females aged 42-81 years were included in this study.The Cobb angle and the range of motion(ROM)of the operative segment were compared before and after the operation.Neck disability index(NDI)and Japanese Orthopedic Association(JOA)scores were used to evaluate neurological function.The modified MacNab criteria were used to evaluate the clinical efficacy during the final follow up.The operation time,blood loss,hospitalization time,and related complications were recorded.Results The operation was performed successfully in 17 patients.The mean operation time,intraoperative blood loss,and hospitalization time were(71.1±10.1)min,(76.9±16.4)mL,and(6.3±1.7)days,respectively.The follow-up time was 12-18(13.7±1.9)months.One patient in the group had dural laceration,while the other patients had no complications,such as spinal cord injury,important vascular injury,cerebrospinal fluid leakage,and wound infection.The Cobb angle of the cervical vertebra at 1 month,3 months,and 12 months after the operation(21.6°±4.2°,24.2°±4.1°,and 22.8°±3.8°,respectively)increased compared with that before the operation(17.8°±3.9°),with statistically significant difference(all P values<0.05).No significant difference was found between the ROM of the operation segment at each time point after and before the operation(all P values>0.05).Significant differences were observed between the NDI at each time point after(16.8%±2.1%,14.3%±1.8%,and 12.3%±1.9%)and before(32.4%±2.4%)the operation(all P values<0.05).Significant differences were also found between different time points in the group(all P values<0.05).In addition,significant differences were observed between the JOA scores at each time point after(12.8±2.4,14.4±1.8,and 15.2±1.9,respectively)and before(8.6±2.2)the operation(all P values<0.05)and between 12 months and 1 month after the operation(P<0.05).In accordance with the modified MacNab criteria,nine patients scored excellent,six scored good,and two scored fair,and the overall excellent and good rate was 15/17 at the final follow up.Conclusions Posterior percutaneous large channel full-endoscopic cervical laminectomy and decompression is a safe and effective method in the treatment of single-segment CSM.It has the advantages of less trauma,rapid postoperative recovery,and good clinical efficacy.However,the surgical indications should be strictly controlled.