经皮后路全内镜下锁孔术与颈前路椎间盘切除融合术治疗神经根型颈椎病的短期疗效

Short-Term Efficacy of Percutaneous PosteriorAll-Endoscopic Keyhole Surgery and ACDF for Cervical Radiculopathy

目的 对比分析经皮后路全内镜下锁孔术和开放颈椎前路椎间盘切除融合术(anterior cervical discectomy and fusion, ACDF)治疗神经根型颈椎病(cervical radiculopathy, CR)短期疗效,探讨CR治疗方案的选择。方法 回顾性分析2019年4月至2021年4月北京电力医院手术治疗的52例CR患者资料,采用经皮后路全内镜下锁孔手术治疗25例(内镜组),其中男14例,女11例,平均年龄(46.61±9.23)岁;采用ACDF治疗27例(融合组),其中男14例,女13例,平均年龄(52.32±9.05)岁。行疼痛视觉模拟评分(visual analogue scale, VAS)、日本骨科协会(Japanese orthopaedic association, JOA)颈椎评分及颈椎功能障碍指数(neck disability index, NDI)评估;末次随访时测定颈椎生理曲度;同时采用改良MacNab疗效评定标准评估手术疗效。结果 两组均顺利完成手术,内镜组手术时间(73.23±7.61) min,融合组手术时间(75.28±8.49) min。内镜组住院时间和恢复工作时间均短于融合组。内镜组和融合组术后3 d、3个月、6个月及12个月时颈部VAS评分均较术前明显降低(P<0.001),术后3 d时内镜组颈部VAS评分明显低于融合组(P<0.05),两组间术后3个月、6个月及12个月时颈部VAS评分比较,差异无统计学意义(P>0.05)。两组术后3 d、3个月、6个月及12个月时NDI评分均较术前明显降低(P<0.001),两组间NDI评分比较,差异无统计学意义(P>0.05)。两组术后3个月、6个月及12个月时JOA评分均较术前升高(P<0.05),两组间JOA评分比较,差异无统计学意义(P>0.05)。内镜组改良MacNab疗效评定结果:优15例,良7例,可2例,差1例,优良率88.00%;融合组改良MacNab疗效评定结果:优17例,良8例,可2例,优良率92.59%。结论 经皮后路全内镜下锁孔术和传统ACDF术治疗CR均可取得良好效果,两种方式均可选择。高龄不能耐受全麻患者更建议考虑经皮后路脊柱内镜下手术治疗。

Objective To compare and analyze the short-term efficacy of percutaneous posterior full-endoscopic key-hole surgery and anterior cervical discectomy and fusion(ACDF)in the treatment of cervical radiculopathy(CR),and to explore the choice of treatment scheme for CR.Methods A retrospective analysis was conducted on the data of 52 CR patients who underwent surgical treatment at Beijing Electric Power Hospital from April 2019 to April 2021.In endoscopic group,25 patients underwent percutaneous posterior full-endoscopic key-hole surgery.This group included 14 males and 11 females,with an average age of(46.61±9.23)years.In fusion group,27 cases were treated with ACDF.This group included 14 males and 13 females,with an average age of(52.32±9.05)years.Visual analog scale(VAS),Japanese orthopaedic association(JOA),neck disability index(NDI)evaluations,physiological curvature measurement of the cervical spine at the last follow-up and modified MacNab efficacy evaluation were used to evaluate the surgical efficacy.Results Both groups of patients successfully completed the surgery,with a surgical time of(73.23±7.61)min in the endoscopic group and(75.28±8.49)min in the fusion group.The hospitalization time and recovery time of the endoscopic group were shorter than those of the fusion group.At 3 days,3 months,6 months,and 12 months after surgery,the neck VAS scores in the endoscopic group and fusion group were significantly lower than those before surgery(P<0.001).At 3 days after surgery,the neck VAS scores in the endoscopic group were significantly lower than those in the fusion group(P<0.05).There was no statistically significant difference in the neck VAS scores between the two groups at 3,6 and 12 months after surgery(P>0.05).The NDI scores at 3 days,3 months,6 months and 12 months after surgery in both groups were significantly lower than those before surgery(P<0.001).There was no statistically significant difference in NDI scores between the two groups(P>0.05).At 3,6 and 12 months after surgery,the JOA scores of the two groups increased compared to those before surgery(P<0.05).There was no statistically significant difference in JOA scores between the two groups(P>0.05).The evaluation results of the improved MacNab efficacy in the endoscopic group were excellent in 15 cases,good in 7 cases,fair in 2 cases,and poor in 1 case,with an excellent and good rate of 88.00%.The evaluation results of the improved MacNab in the fusion group were excellent in 17 cases,good in 8 cases,and fair in 2 cases,with an excellent and good rate of 92.59%.Conclusion Percutaneous posterior endoscopic key-hole surgery and traditional ACDF can both achieve good results in the treatment of CR.Both methods can be selected.The elderly patients who cannot tolerate general anesthesia are more recommended to consider percutaneous posterior endoscopic spinal surgery.