后路经皮内窥镜下颈椎椎间盘切除术治疗双节段神经根型颈椎病的中远期疗效

Midium and long term efficacy of posterior percutaneous endoscopic cervical discectomy in treatment of double-segment cervical spondylotic radiculopathy

目的探讨后路经皮内窥镜下颈椎椎间盘切除术(PECD)治疗双节段神经根型颈椎病(CSR)的中远期疗效。方法2015年1月—2017年1月,海军军医大学长征医院采用PECD治疗双节段CSR患者38例。测量患者术前及术后各随访时间点颈椎Cobb角、手术节段椎间隙高度、手术节段椎间水平位移和角位移。术前及术后各随访时间点采用疼痛视觉模拟量表(VAS)评分评估患者颈肩痛和上肢神经根性疼痛程度;采用日本骨科学会(JOA)评分评价颈椎功能;采用改良MacNab标准评估手术疗效。结果所有手术顺利完成,所有患者随访(55.0±12.4)个月。术后各随访时间点颈椎Cobb角、手术节段椎间隙高度、手术节段椎间水平位移和角位移与术前相比,差异均无统计学意义(P>0.05)。术后各随访时间点,患者颈肩痛和上肢神经根性疼痛VAS评分及JOA评分较术前改善,差异均有统计学意义(P<0.05)。末次随访时,按照改良MacNab标准评定疗效优良率为89.5%(31/38)。结论PECD治疗双节段CSR具有创伤小、并发症少、对脊柱稳定性影响小、术后恢复快等优点,中远期疗效可靠。

Objective To investigate the medium and long term efficacy of posterior percutaneous endoscopic cervical discectomy(PECD)in the treatment of double-segment cervical spondylotic radiculopathy(CSR).Methods From January 2015 to January 2017,38 patients with double-segment CSR were treated with PECD in Changzheng Hospital of Naval Medical University.The cervical Cobb angle,the intervertebral space height,and horizontal and angle displacement at the operative segment were measured before operation and during follow-up.The intersity of neck and shoulder pain and upper limb radicular pain were evaluated by pain visual analogue scale(VAS)score before operation and during follow-up.The cervical function was evaluated by Japanese Orthopaedic Association(JOA)score.The modified MacNab criteria was used to evaluate the surgical effect.Results All the operations were successfully completed,and all the patients were followed up for(55.0±12.4)months.There was no significant difference in cervical Cobb angle,the intervertebral space height,and horizontal and angle displacement at the operative segment at each follow-up time point after operation compared with those before operation(P>0.05).The VAS scores of neck and shoulder pain and upper limb radicular pain and JOA scores at each follow-up time point after operation were significantly improved compared with those before operation(P<0.05).At the final follow-up,the excellent and good rate of curative effect was 89.5%(31/38)according to modified MacNab criteria.Conclusions PECD in the treatment of double-segment CSR has the advantages of less trauma,less complications,less impact on spinal stability and rapid postoperative recovery.The medium and long-term efficacy is reliable.