颈椎前路减压融合内固定和O臂导航下经皮颈椎后路椎间孔K-hole技术治疗单节段神经根型颈椎病的临床疗效对照研究

A Comparative Study of the Clinical Effects of Anterior Cervical Decompression,Fusion and Internal Fixation and Percutaneous Posterior Cervical Intervertebral Foramen K-Hole Technique Under the Guidance of O-Arm Navigation in the Treatment of Single-Level Cervical Spondylotic Radiculopathy

目的:探讨颈椎前路减压融合内固定和O臂导航下经皮颈椎后路椎间孔K-hole技术治疗单节段神经根型颈椎病的临床疗效。方法:纳入2019年2月~2022年8月在本科室住院并接受手术治疗的单节段神经根型颈椎病27例,按患者病情及意愿分为观察组(O臂辅助下颈椎后路椎间孔镜)13例和对照组(颈椎前路减压融合内固定)14例,观察并比较各组患者的围手术期参数、影像学和临床疗效等指标。结果:27例患者均获得随访,随访时间为6~24个月,平均15个月,无内固定物脱落、断裂情况。2组比较,观察组手术时间、出血量较对照组长(P<0.05)。在椎间隙高度方面,观察组术后高度较术前时下降(P<0.05),而对照组术后较术前时增加(P<0.05)。在颈椎生理曲度改善方面,观察组术后与术前比较差异无显著性意义(P>0.05),而对照组则相反(P<0.05)。两组患者随访视觉模拟评分法评分、颈椎功能障碍指数评分均明显低于术前有显著性意义(P<0.05),但是组间比较差异无显著性意义(P>0.05)。结论:两种手术方法治疗单节段神经根型颈椎病均能取得良好治疗效果,而且两者间的临床效果无明显差异。随着手术程度不断熟练,手术时间不断缩短,患者对切口外观要求增高,在严格掌握手术适应证的基础上,O臂导航下经皮颈椎后路椎间孔K-hole技术治疗单节段神经根型颈椎病将在临床上得到更多的应用。

Objective:To investigate the clinical effect of anterior cervical decompression,fusion and internal fixation and percutaneous posterior cervical intervertebral foramen K-hole technique under O-arm navigation in the treatment of single-level cervical spondylotic radiculopathy.Methods:A total of 27 patients with single level cervical spondylotic radiculopathy who were hospitalized and received surgical treatment in our department from February 2019 to August 2022 were divided into an observation group(O-arm assisted posterior cervical discectomy)of 13 patients and a control group(anterior cervical decompression,fusion,and internal fixation)of 14 patients according to their condition and willingness.Perioperative parameters,imaging,and clinical efficacy of each group were observed and compared.Results:All 27 patients were followed up for a period of 6 to 24 months,with an average of 15 months.There were no cases of internal fixation detachment or breakage.Compared with the control group,the observation group had a shorter surgical time and bleeding volume(P<0.05).In terms of intervertebral space height,the observation group's postoperative height decreased compared to preoperative height(P<0.05),while the control group's postoperative height increased compared to preoperative height(P<0.05).In terms of improving cervical physiological curvature,there was no significant difference between the observation group after surgery and before surgery(P>0.05),while the control group had the opposite effect(P<0.05).The follow-up visual simulation score and cervical dysfunction index score of the two groups of patients were significantly lower than preoperative scores(P<0.05),but there was no significant difference between the groups(P>0.05).Conclusion:Both of the two surgical methods can achieve good results in the treatment of single-segment cervical spondylotic radiculopathy,and there is no significant difference in the clinical effect between the two methods.With the increasing proficiency of the operation,the shortening of the operation time,and the increasing requirements of the patients on the appearance of the incision,on the basis of strictly mastering the surgical indications,the percutaneous posterior cervical intervertebral foramen K-hole technology under the guidance of the O-arm will be more widely used in the clinical treatment of single-segment cervical radiculopathy.