全身麻醉下后路内镜治疗外侧型颈椎间盘突出症*

Posterior percutaneous endoscopic for lateral cervical intervertebral disc herniation under general anesthesia*

摘要:

摘要：目的??探讨全身麻醉下后路经皮内镜下颈椎间盘髓核摘除术治疗外侧型颈椎间盘突出症的临床疗效。方法 回顾性分析2016年5月－2018年4月该科采用全身麻醉下颈椎后路椎间孔镜下髓核摘除术治疗外侧型颈椎间盘突出症患者15例，术后2～5 d复查颈椎CT/MRI评估减压情况，记录患者术前术后的颈肩部及上肢疼痛的视觉模拟量表（VAS）评分、日本骨科协会（JOA）评分、颈椎手术节段的稳定性和椎间高度的变化，并进行统计学分析。结果 15例均顺利完成手术，平均手术时间（72.87±26.70）min；术后平均住院时间（3.53±0.74）d；15例均获随访，平均随访时间（14.87±2.62）个月，术前、术后1?d、术后1个月、3个月、6个月及末次随访的VAS评分分别为（7.00±1.20）、（1.07±0.80）、（0.93±0.80）、（0.87±0.64）、（0.73±0.70）和（0.80±0.77）分；术前与术后各时间点VAS评分比较，差异均有统计学意义（P??0.05）；术前及术后无一例患者颈椎手术节段不稳定。根据改良Macnab标准，末次随访时对临床疗效进行评价，优12例，良2例，可1例。结论 全身麻醉下颈椎后路孔镜下髓核摘除术治疗单节段外侧型颈椎间盘突出症是一种微创、安全、有效的手术方式，但其远期疗效和对颈椎间盘退变、颈椎稳定性的影响有待进一步观察。

Abstract:

Abstract: Objective?To investigate the clinical efficacy of posterior percutaneous endoscopic cervical discectomy in treatment of lateral cervical disc herniation under general anesthesia.?Methods?From May 2016 to April 2018, 15 patients were treated with posterior percutaneous endoscopic cervical discectomy under general anesthesia. The cervical spine CT/MRI at 2 to 5 days was used to evaluate decompression postoperation. The Visual Analogue Scale (VAS) scores, Japanese Orthopaedic Association (JOA), the stability of the cervical spine segment, and the changes in intervertebral height of patients with cervical, shoulder and upper limb pain before and after surgery were recorded and statistically analyzed.?Results?All the 15 patients completed operation successfully, the average operation time was (72.87?±?26.70) min; the average hospital stay was (3.53?±?0.74) d; 15 patients were all obtained follow-up, mean follow-up time (14.87?±?2.62) months. The VAS were (7.00?±?1.20), (1.07?±?0.80), (0.93?±?0.80), (0.87?±?0.64), (0.73?±?0.70), (0.80?±?0.77) at preoperation, postoperative 1 d, 1 month, 3 month and 6 month, the last follow-up, respectively; VAS scores preoperative and postoperative 1D, 1M, 3M, 6M and last follow-up, the paired t-test showed statistically significant differences (P??0.05); There was no patient with unstable cervical segment before and after surgery. According to the clinical efficacy evaluation of the modified Macnab standard at the last follow-up, 12 cases were excellent; 2 cases were good and 1 case was fair.?Conclusions?The treatment of single-segment lateral cervical disc herniation under general anesthesia is a minimally invasive, safe and effective surgical method, but its long-term efficacy and the effects of cervical disc degeneration and cervical stability need further observation.