[1]刘鏐△ 方杰 李涛 李莹 吴从俊.后路经皮脊柱内镜减压术治疗神经根型颈椎病42例[J].中国中医骨伤科杂志,2021,29(09):69-73.
　LIU Liu FANG Jie LI Tao LI Ying WU Congjun.Treatment of Cervical Spondylotic Radiculopathy Adopting theReleasing of Nerve Root by Posterior PercutaneousEndoscopic Cervical Discectomy: 42 Cases Report[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2021,29(09):69-73.
点击复制

后路经皮脊柱内镜减压术治疗神经根型颈椎病42例()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第29卷
期数:
2021年09期
页码:
69-73
栏目:
临床报道
出版日期:
2021-09-15

文章信息/Info

Title:
Treatment of Cervical Spondylotic Radiculopathy Adopting theReleasing of Nerve Root by Posterior PercutaneousEndoscopic Cervical Discectomy: 42 Cases Report
文章编号:
1005-0205(2021)09-0069-05
作者:
刘鏐1△ 方杰2 李涛1 李莹1 吴从俊1
1湖北六七二中西医结合骨科医院(武汉,430079)
2武汉市蔡甸区中医院
Author(s):
LIU Liu1△ FANG Jie2 LI Tao1 LI Ying1 WU Congjun1
1Department of Minimally Invasive Spine,Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine,Wuhan 430079,China; 2Wuhan City Caidian Hospital of Traditional Chinese Medicine,Wuhan 430101,China.
关键词:
神经根型颈椎病;  后路经皮颈椎内镜技术;  颈椎管减压
Keywords:
cervical spondylotic radiculopathy;  posterior percutaneous endoscopic cervical discectomy;  releasing of nerve root
分类号:
R681.5
文献标志码:
B
摘要:
目的:观察后路经皮脊柱内镜减压术治疗神经根型颈椎病的临床疗效,并记录评价指标为该技术的有效性和安全性研究提供参考。方法:于2015年3月至2020年1月,对42例确诊为神经根型颈椎病的病例,在全麻下采取后路经皮脊柱内镜减压术。其中5例C4～5,28例C5～6,9例C6～7; 年龄 32～71岁,平均45岁; 统计术前及术后1 d、2周、3个月、6个月、12个月各时间节点患者颈肩及上肢VAS评分和颈椎病JOA评分,并进行统计学分析,末次随访采用改良MacNab标准评价该术式临床疗效。术后均复查颈椎MRI、CT(平扫+三维重建+三维成像),观察施术节段椎间稳定性、椎间塌陷及复查颈椎MRI、CT(平扫+三维重建+三维成像),观察施术节段椎间稳定性、椎间塌陷及退化增生改变情况。结果:所有患者施术顺利并获得12个月以上随访,术前神经系统机械性压迫症状得到缓解,短期随访2例患者残余颈项部轻度疼痛,3例残余轻微手部麻木症状,1例出现下肢脊髓症状。对术前与术后随访各时间点颈肩及上肢VAS评分和颈椎病JOA评分数据进行统计学分析,术前术后比较差异有统计学意义(P<0.05)。依据改良MacNab疗效评定标准评估其临床疗效,其中优34例,良6例,可2例,差0例。术后复查相关颈椎MRI、CT平扫+三维重建提示责任节段脱出髓核、增生黄韧带、Luschka关节和关节突关节等骨性增生皆获得充分清除,神经根及硬膜囊周围组织松解彻底,近期颈椎系统序列无明显改变,未出现明显稳定性降低和(或)椎间隙塌陷,未新发骨性或软组织增生。结论:后路经皮颈椎内镜技术有稳定可靠的临床近中期疗效,术中提供清晰和灵活的水介质视野,保证了施术安全性和充分性,规避了传统开放手术对正常组织器官的干扰,不破坏正常椎间盘组织,神经组织侵袭少,该技术对传统神经根型颈椎病诊疗思路的转变有实际参考价值。
Abstract:
Objective:To observe actual clinical efficacy and safety of posterior percutaneous endoscopic cervical discectomy in the treatment of cervical spondylotic radiculopathy.Methods:A total of 42 patients with cervical spondylotic radiculopathy diagnosed in our hospital were treated by posterior percutaneous endoscopic cervical discectomy PPECD from March 2015 to January 2020.Among them,5 cases were C4～5,28 cases were C5～6,and 9 cases were C6～7.They were aged from 32 to 71 with 45 years old on average.JOA and VAS scores of the patients were recorded before and 1 d,2 weeks,3 months,6 months and 12 months after surgery.Modified MacNab recorded in the last follow-up to evaluate its clinical efficacy.Postoperative MRI and CT of the cervical spine were reexamined to observe the intervertebral stability,intervertebral collapse and degeneration and hyperplasia of the operative segment.Results:All patients were successfully operated and followed up for 1 year.The preoperative mechanical compression symptoms of the nervous system were relieved.During short-term follow-up,2 patients showed mild residual neck pain,3 patients showed minor residual hand symptoms,and 1 patient had lower limb spinal cord symptoms.JOA and VAS scores were compared between preoperative and postoperative among the time points,and the differences were statistically significant(P<0.05).The clinical efficacy was evaluated according to the modified MacNab efficacy evaluation criteria,among which 34 cases were excellent,6 cases were good,2 cases were fair,and 0 cases was poor.Postoperative MRI and 3D CT reconstruction of the cervical spine indicated that the nerve roots and the surrounding dural sac were absolutely cleaned,the nervous system tissue was completely released,the recent cervical system sequence was not significantly changed,the degeneration was not obvious,and there was no significant stability reduction or intervertebral collapse.Conclusion:Posterior percutaneous endoscopic cervical discectomy has stable and reliable clinical curative effect in short-term and medium-term following up.It provides clear vision during the operative,and flexible view under water ensures the operation safety and sufficiency,effectively avoid the traditional open surgery disturbance to the normal tissues and organs,does not destroy normal intervertebral disc tissue,less nerve tissue invasion.It has practical reference value to the traditional of the transition of the idea of diagnosis and treatment on cervical spondylotic radiculopathy.

参考文献/References:

[1] TACCONI L,BOBICCHIO P.Preliminary results of a novel pure endoscopic procedure in the treatment of degenerative lumbar spinal disorders:double endoscopic technique[J].J Neurosurg Sci,2018,21(1):51-57.
[2] KAGAWA E,NIMURA A,NASU H,et al.Fibrous connection between cervical nerve and zygapophysial joint and implication of the cervical spondylotic radiculopathy[J].Spine,2020,12(17):23-34.
[3] 孙兆忠,郑振阳,李瑞,等.经皮颈椎后路内窥镜术安全性的应用解剖学[J].中国矫形外科杂志,2017,25(7):652-656.
[4] RUETTEN S,KOMP M,MERK H,et al.Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes:a prospective,randomized,controlled study[J].Spine(Phila Pa 1976),2008,33(9):940-948.
[5] 刘鑫,孙兆忠,程艳,等.颈椎后路经皮内镜开窗安全性3D-CT分析[J].中国矫形外科杂志,2018,26(3):247-251.
[6] 杨学军,梁鹏展,陈晓东,等.颈椎后路经皮内镜椎间盘切除术对单节段神经根型颈椎病患者NDI指数与ROM的影响.临床研究[J].中国医学创新,2020,17(27):32-36.
[7] 袁帅,蒋毅,左如俊,等.颈椎后路经皮内镜下椎间盘切除术后脊髓损伤1例报道[J].中国脊柱脊髓杂志,2020,30(2):188-192.
[8] BADIEE R K,MAYER R,PENNICOOKE B,et al.Complications following posterior cervical decompression and fusion:a review of incidence,risk factors,and prevention strategies[J].Spine Surg,2020,6(1):323-333.
[9] 赵馨扬,于胜波.颈椎静脉丛的解剖特点及其临床意义[J].中国临床解剖学杂志,2017,35(5):593-595.
[10] URBANSCHITZ L,MERAT S,BENSLER S,et al.Cervical disc degeneration reduces distance between vertebral artery and surgical landmarks[J].Clin Neurol Neurosurg,2021,200:106332.
[11] PAOLINI S,LANZINO G.Anatomical relationships between the V2 segment of the vertebral artery and the cervical nerve roots[J].J Neurosurg Spine,2006,5(5):440-442.
[12] YAO S D,OUYANG B P,LU T S,et al.Treatment of cervical spondylotic radiculopathy with posterior percutaneous endoscopic cervical discectomy:short-term outcomes of 24 cases[J].Medicine(Baltimore),2020,99(20):9-22.
[13] REN J B,LI R,ZHU K,et al.Biomechanical comparison of percutaneous posterior endoscopic cervical discectomy and anterior cervical decompression and fusion on the treatment of cervical spondylotic radiculopathy[J].J Orthop Surg Res,2019,14(1):71-79.

备注/Memo

备注/Memo:
基金项目:武汉市临床医学科研项目(WX20D19)
△通信作者 E-mail:babycow_ll@hotmail.com
更新日期/Last Update: 1900-01-01