后路经皮内窥镜下颈椎间盘切除术治疗神经根型颈椎病的临床应用

doi:10.3969/j.issn.1004-406X.2018.06.02

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题名	后路经皮内窥镜下颈椎间盘切除术治疗神经根型颈椎病的临床应用
其他题名	Clinical application of posterior percutaneous endoscopic cervical discectomy in the treatment of cervical spondylotic radiculopathy
作者	朱旻宇1; 滕红林1; 黄克伦1; 王宇1; 林超伟1; 吴诗阳1; 王建洪 2
发表日期	2018-06-25
发表期刊	中国脊柱脊髓杂志影响因子和分区
语种	中文
原始文献类型	学术期刊
关键词	后路经皮脊柱内镜椎间盘切除术神经根型颈椎病
摘要	目的 :评价后路经皮内窥镜下颈椎间盘切除术(posterior percutaneous endoscopic cervical discectomy,PPECD)治疗神经根型颈椎病的临床应用价值。方法:2013年1月~2016年10月,共有43例单节段神经根型颈椎病患者入选,随机分入两个手术组并获得至少1年随访。其中采用颈前路减压椎间植骨融合内固定术(anterior cervical decompression and fusion,ACDF)治疗23例,随访时间23.1±5.9个月;采用PPECD治疗20例,随访时间25.6±8.3个月。比较两组患者的手术时间、术后住院天数、住院费用、术前及术后各随访点(1d、1周、1个月、3个月、1年)的上肢疼痛VAS评分、创口疼痛VAS评分,术前及术后1年颈椎前凸Cobb角、颈椎活动度、颈椎功能障碍指数(neck disability index,NDI)评分、轴性症状发生率、重返工作岗位时间等情况,记录术后并发症情况,并在术后1年随访时进行Macnab临床疗效评价。结果:两组平均手术时间无显著性差异(P>0.05),术后1d时ACDF组及PPECD组的上肢疼痛VAS评分分别为1.13±1.78分、1.02±2.24分,两组间无显著性差异(P>0.05),且较术前的7.13±1.25分、7.28±1.30分均有显著改善(P<0.05);术后1d时PPECD组的创口疼痛VAS评分为1.91±0.58分,显著小于ACDF组的3.87±1.19分(P<0.05),但术后1周后随访两组间无显著性差异(P>0.05)。此外,PPECD组在平均术后住院天数、住院费用、重返工作岗位时间等方面均显著小于ACDF组(P<0.05)。ACDF组和PPECD组术后1年时颈椎前凸Cobb角分别为13.7°±6.9°和8.2°±4.8°,较术前的4.3°±11.3°、4.7°±8.9°均有显著增大(P<0.05),且ACDF组的平均增幅显著大于PPECD组(P<0.05)。术后1年时PPECD组的颈椎活动度同术前无显著性差异(P>0.05),但ACDF组较术前显著减小(P<0.05)。术后1年时NDI评分、轴性症状发生率及Macnab临床疗效评价优良率方面两组间无显著性差异(P>0.05)。结论:PPECD治疗神经根型颈椎病的临床疗效与ACDF相当,但前者手术创伤更小,术后恢复更快,费用更少,可作为临床治疗的术式选择。
其他摘要	Objectives: Through clinical comparative study, the clinical application value and advantages and disadvantages of posterior percutaneous endoscopic cervical discectomy (PPECD) in the treatment of radicular cervical spondylosis were evaluated. Methods: A prospective study. A total of 43 patients who were treated for cervical spondylotic radiculopathy between January 2013 and October 2016 were prospectively included in the study and obtained at least 1-year follow-up. The patients were randomly divided into the anterior cervical discectomy and fusion(ACDF) group with 23 patients and the PPECD group with 20 patients, follow-up for 23.1±5.9 month and 25.6±8.3 month respectively. The patient′s surgical time, length of hospitalization, inpatients expenses, pre-operative and post-operative upper limb VAS, surgical incision VAS, pre- and postoperative 1-year cervical Cobb angle, cervical motion range, neck disability index(NDI) score, rate of cervical axis symptom, the time return to work and post-operative 1-year Macnab score was analyzed. Results: The difference in surgical time was statistically insignificant (P>0.05). At post-operative 1d, the upper limp VAS changed from 7.13±1.25 to 1.37±0.71 for the ACDF group and from 7.28±1.30 to 1.45±0.81 for the PPECD group. The change between pre- and post-operation upper limb VAS was statistically significant(P<0.05), but the difference between both groups at post-operative 1d was statistically insignificant(P>0.05). At post-operative 1d, the difference in surgical incision VAS was statistically significant (P<0.05) where the ACDF group (3.87±1.19) was greater than the PPECD group(1.91±0.58). However, at post-operative 1 week, the difference in surgical incision VAS was statistically insignificant(P>0.05). The length of hospital stays, inpatient expenses and the time return to work in PPECD group was significantly lower than ACDF group (P<0.05). The preand post-operative 1-year cervical Cobb angle for the ACDF group was 4.3°±11.3° and 13.7°±6.9° respectively; the difference was statistically significant (P<0.05) whereas pre- and post-operative 1-year cervical Cobb angle for the PPECD group was 4.7°±8.9° and 8.2°±4.8° respectively where the difference was statistically insignificant(P>0.05). The range of cervical motion in ACDF group decreased significantly(P>0.05) but in the PPECD group, no obvious decrease in range of motion was observed(P>0.05). The NDI score, rate of postoperation cervical axis symptom and Macnab score in both groups showed no difference at post-operative 1 year follow-up (P>0.05). Conclusions: The clinical effectiveness of PPECD and ACDF in treating cervical spondylotic radiculopathy is equivalent. However, PPECD can be favored due to the surgical incision, inpatient expenses, post-operative recovery.
ISSN	1004-406X
卷号	28 期号:06 页码:488-495
DOI	10.3969/j.issn.1004-406X.2018.06.02
页数	8
收录类别	CNKI ; 万方 ; 维普 ; 北大核心 ; PKU ; CSCD ; ISTIC
学科领域	医药、卫生 ; 外科学
URL	查看原文
CSCD记录号	CSCD:6278070
引用统计
文献类型	期刊论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/46753
专题	第二临床医学院、附属第二医院、育英儿童医院_外科学_脊柱外科附属第一医院
作者单位	1.温州医科大学附属第一医院脊柱外科; 2.浙江省玉环市人民医院骨科
第一作者单位	附属第一医院
第一作者的第一单位	附属第一医院
推荐引用方式 GB/T 7714	朱旻宇,滕红林,黄克伦,等. 后路经皮内窥镜下颈椎间盘切除术治疗神经根型颈椎病的临床应用[J]. 中国脊柱脊髓杂志,2018,28(06):488-495.
APA	朱旻宇., 滕红林., 黄克伦., 王宇., 林超伟., ... & 王建洪. (2018). 后路经皮内窥镜下颈椎间盘切除术治疗神经根型颈椎病的临床应用. 中国脊柱脊髓杂志, 28(06), 488-495.
MLA	朱旻宇,et al."后路经皮内窥镜下颈椎间盘切除术治疗神经根型颈椎病的临床应用".中国脊柱脊髓杂志 28.06(2018):488-495.

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