后路经皮脊柱内镜下髓核摘除术治疗神经根型颈椎病35例

35 Cases Clinical Study for Efficacy of Posterior Percutaneous Spinal Endoscopy Discectomy in Treating Cervical Spondylotic Radiculopathy

目的:探讨颈椎后路经皮脊柱内镜椎间盘髓核切除术(Posterior Percutaneous Endoscopic Cervical Discectomy,PPECD)治疗神经根型颈椎病(Cervical Spondylotic Radiculopathy,CSR)的安全性和临床疗效。方法:2016年1月至2019年12月采用PPECD治疗35例CSR,于患者术前、出院时、术后1个月、3个月、6个月及12个月时采用数字评分法(Numeric Rating Scales,NRS)评估疼痛程度、颈椎功能障碍指数(Neck Disability Index,NDI)和日本骨科协会评分量表(Japanese Orthopaedic Association,JOA)评估功能恢复,末次随访时采用改良MacNab分级和MRI评估临床疗效。结果:35例患者中男16例,女19例;年龄39~78岁,平均(54.0±9.9)岁;手术节段为C_(4~5)9例,C_(5~6)15例,C_(6~7)11例。35例手术患者均顺利完成手术,均完成术后12个月以上随访,平均随访26.7个月(13~53个月)。术后各时间段NRS指数较术前明显降低,差异有统计学意义(P<0.01);NDI和JOA指数均明显低于术前,差异有统计学意义(P<0.01)。末次随访时评价临床疗效,优20例、良12例、可3例,优良率达91.4%。随访期间均未发生神经根损伤、硬膜囊撕裂或感染等并发症,且无患者因症状复发需要接受二次微创或开放手术治疗。结论:严格把握适应证的前提下,PPECD治疗CSR术后疗效确定,患者满意度高。

Objective:To investigate the safety and clinical efficacy of posterior percutaneous endoscopic discectomy(PPECD)on the treatment of cervical spondylotic radiculopathy(CSR).Methods:35 cases of CSR from January 2016 to December 2019 were treated with PPECD.The degree of pain was evaluated by numeric rating scales(NRS)before operation,at discharge,1 month,3 months,6 months,1 year after operation and at the last follow-up.The functional recovery was evaluated by neck disability index(NDI)and Japanese orthopedic association(JOA).The clinical efficacy was evaluated by modified MacNab grading and MRI at the last follow-up.Results:Among the 35 patients,there are 16 males and 19 females were aged 39 to 78 years old,with an average age of(54.0±9.9)years old.The operative segments were C_(4-5)(9 cases),C_(5-6)(15 cases)and C_(6-7)(11 cases).All 35 patients successfully completed the operation.All 35 patients were followed up for more than one year after operation,with an average follow-up of 26.7 months(13 to 53 months).The NRS index was significantly lower in each period than before operation(P<0.01).NDI and JOA index were significantly lower than those before operation(P<0.01).The clinical efficacy was evaluated at the last follow-up.20 cases were excellent,12 cases were good,3 cases were fine,and the excellent rate was 91.4%.No complications such as nerve root injury,dural sac tear or infection occurred during the follow-up period,and no patients needed to receive secondary minimally invasive or open surgery for symptom recurrence.Conclusion:Under the premise of strictly grasping the indications,the curative efficacy of PPECD on the treatment of CSR is confirmed,and the patients’satisfaction is high.