低温等离子髓核消融术治疗颈椎间盘突出症临床研究

Clinical Study of Percutaneous Cervical Disc Nucleoplasty on the Treatment of Cervical Disc Herniation

目的:探讨低温等离子髓核消融术(Percutaneous Cervical Disc Nucleoplasty,PCDN)治疗颈椎间盘突出症(Cervical Disc Herniation,CDH)的中期疗效及其影响因素。方法:回顾性分析2019年1月至2020年1月行低温等离子髓核消融术治疗的80例颈椎间盘突出症患者资料,所有患者术后均获随访2年,根据颈椎功能障碍指数(NDI)评分、视觉模拟量表(VAS)评分、日本骨科协会(JOA)评分和改良MacNab标准评价低温等离子髓核消融术治疗颈椎间盘突出症的临床疗效。对患者的性别、体重指数(BMI)、手术节段、主要症状、年龄及病程进行单因素分析和多因素逻辑回归分析,探讨低温等离子髓核消融术的影响因素。结果:与术前相比,所有患者术后2年的NDI评分、VAS评分、JOA评分显著降低,差异有统计学意义(P<0.05)。末次随访时,优22例,良32例,中7例,差19例,总优良率为67.5%。单因素分析显示,年龄、病程、是否以头晕为主要症状均是临床疗效的影响因素;多因素回归分析显示,年龄在20~30岁(OR=0.107)、病程<6个月(OR=0.506)以及以头晕为主要症状(OR=0.176)的患者,临床效果及预后相对较好。结论:低温等离子髓核消融术治疗颈椎间盘突出症具有良好的中期疗效,年龄小、病程短、以头晕为主的颈椎间盘突出症患者临床疗效相对较好。

Objective:To investigate the medium-term efficacy and influencing factors of percutaneous cervical disc nucleoplasty(PCDN)on the treatment of cervical disc herniation(CDH).Methods:The data of 80 patients with CDH treated by PCDN from January 2019 to January 2020 were analyzed retrospectively.All patients were followed up for 2 years.The clinical efficacy of PCDN on the treatment of CDH was evaluated according to neck disability index(NDI)score,visual analogue scale(VAS)score,Japanese orthopaedic association(JOA)score and modified MacNab standard.The sex,body mass index(BMI),operative segment,main symptoms,age and course of disease were analyzed by univariate analysis and multivariate logical regression analysis to explore the influencing factors of hypothermic plasma nucleus pulposus ablation.Results:Compared with those before operation,NDI score,VAS score and JOA score of all patients decreased significantly 2 years after operation(P<0.05).At the last follow-up,the results were excellent in 22 cases,good in 32 cases,fair in 7 cases and poor in 19 cases.The total excellent and good rate was 67.5%.Univariate analysis showed that age,course of disease and dizziness were the main symptoms of dizziness,while multivariate regression analysis showed that patients aged from 20 to 30 years old(OR=0.107),course of disease less than 6 months(OR=0.506)and dizziness as the main symptom(OR=0.176)had a good overall prognosis.Conclusion:PCDN has a good medium-term efficacy on the treatment of CDH,and the clinical efficacy of CDH patients with young age,short course of disease and dizziness is relatively good.