后路经皮脊柱内镜技术治疗单节段神经根型颈椎病的短期临床疗效

Short-term clinical effect of posterior percutaneous spinal endoscopy in treatment of single-segment cervical spondylotic radiculopathy

摘要:

目的 探讨颈椎后路经皮脊柱内镜椎间盘髓核切除术（PPECD）治疗单节段神经根型颈椎病（CSR）的临床疗效。方法 回顾性分析2019年1月－2019年12月于甘肃省中医院行PPECD治疗的18例单节段CSR患者的临床资料，于术前及术后随访时采用数字分级评分法（NRS）、颈椎功能障碍指数（NDI）和日本骨科协会（JOA）评分表评估患者疼痛和功能恢复情况，末次随访时采用改良MacNab分级评定临床疗效。结果 18例患者均顺利完成手术。手术时间60～90 min，平均（76.1±7.8）min；术中出血量10～22 mL，平均（16.2±3.5）mL；术后住院4～10 d，平均（6.8±1.4）d；术后随访13～24个月，平均18.4个月。术后颈椎曲度较术前明显增大（P < 0.01），术后病变节段椎间高度较术前降低（P < 0.05）。术后各时间段NRS和NDI均较术前明显降低（P < 0.05），JOA评分明显高于术前（P < 0.05）。末次随访时评价临床疗效，10例为优，6例为良，2例为可，优良率为88.9%。随访期间均无并发症发生。结论 在严格把握适应证的前提下，PPECD治疗单节段CSR术后疗效确定，患者满意度高。

Abstract:

Objective To explore the clinical efficacy of posterior percutaneous endoscopic cervical discectomy (PPECD) in treatment of single-segment cervical spondylotic radiculopathy (CSR).Methods Clinical data of 18 patients with single-segment CSR treated with PPECD from January 2019 to December 2019 were retrospectively analyzed, patient’s pain and functional recovery were assessed by numerical rating scale (NRS), neck disability index (NDI) and Japanese Orthopaedic Association (JOA) Rating Scale at preoperative and postoperative follow-up, the clinical efficacy was evaluated by modified MacNab grading at the last follow-up.Results All the 18 patients successfully completed the operation. The operation time was 60 ~ 90 min, with an average of (76.1 ± 7.8) min; intraoperative blood loss was 10 ~ 22 mL, with an average of (16.2 ± 3.5) mL; The postoperative hospital stay was 4~10 d, with an average of (6.8 ± 1.4) d; Postoperative follow-up lasted from 13~24 months, averaging 18.4 months. The curvature of the cervical spine after operation was significantly larger than that before operation (P < 0.01), and the intervertebral height of the diseased segment after operation was decreased compared with that before operation (P < 0.05). The NRS and NDI in each time period after operation were significantly lower than those before operation (P < 0.05), and JOA was significantly higher than that before operation (P < 0.05). The clinical efficacy was evaluated at the last follow-up, 10 cases were excellent, 6 cases were good, and 2 cases were general, the excellent rate was 88.9%. No complications occurred during the follow-up period.Conclusion Under the premise of strictly grasping the indications, the curative effect of PPECD in treatment of single-segment CSR is confirmed, and patient satisfaction is high.