经皮全内镜前路经椎体颈椎间盘切除术和通道修复：技术报告。
Percutaneous full-endoscopic anterior transcorporeal cervical discectomy and channel repair: a technique note report.
机构信息
Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.
Joint Orthopaedic Research Center of Zunyi Medical University & University of Rochester Medical Center (JCMR-ZMU & URMC), Zunyi Medical University, Zunyi, 563000, Guizhou, China.
出版信息
BMC Musculoskelet Disord. 2019 Jun 10;20(1):280. doi: 10.1186/s12891-019-2659-0.
BACKGROUND
Compared to anterior cervical discectomy and fusion (ACDF), cervical motion segment and disc was retained through anterior transcorporeal herniotomy (ATH). But surgical field and manipulation in traditional ATH was restricted by the narrow channel. Percutaneous full-endoscopic transdiscal cervical discectomy is a minimally invasive and functional spine surgery. However, significant loss of intervertebral disc height was inevitable. This study was done to illustrate the feasibility, safety, and efficacy and present our surgical experience of percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) and channel repair (CR) for the treatment of cervical disc herniation (CDH).
METHODS
Four patients with CDH were chosen to undergo PEATCD and CR with a follow-up care for at least 22 months. The visual analogue score (VAS), Japanese Orthopedic Association (JOA), and modified Macnab criteria were recorded during the postoperative periods. CT images were obtained to observe the healing of the channel at 1 week and 3 months after the operation.
RESULTS
The average operating time was 83.75 min. Drainage tubes were unnecessary. No procedure-related complications occurred. The postoperative VAS and JOA scores were improved compared to those of the preoperative assessment. The clinical efficacy was excellent in 3 patients and good in 1 patient at final follow up stage according to the modified Macnab criteria. The hernia was removed completely in all patients according to postoperative MRI. Migration of the repair implementation and collapse of the drilled vertebrae were not observed during the postoperative periods. The bony channel was nearly absent on CT images obtained at 3 months postoperative.
CONCLUSION
This is the first time that the anterior transcorporeal cervical discectomy and CR have been performed simultaneously under endoscopy. Less damage to disc and the retained cervical motion segment were achieved through this method. This is a feasible, safe, and minimally invasive procedure.
TRIAL REGISTRATION
Numbers: ChiCTR1800016383 . Registered 29 may 2018. Retrospectively registered.
TRIAL REGISTRY
Chinese Clinical Trial Registry.
背景
与前路颈椎间盘切除融合术（ACDF）相比，前路经椎体切开术（ATH）保留了颈椎运动节段和椎间盘。但传统 ATH 的手术视野和操作受到狭窄通道的限制。经皮全内镜经椎间盘颈椎切除术是一种微创的脊柱功能手术。然而，椎间盘高度的显著丢失是不可避免的。本研究旨在阐明经皮全内镜前路经椎体颈椎间盘切除术（PEATCD）和通道修复（CR）治疗颈椎间盘突出症（CDH）的可行性、安全性和疗效，并介绍我们的手术经验。
方法
选择 4 例 CDH 患者行 PEATCD 和 CR 治疗，随访至少 22 个月。记录术后视觉模拟评分（VAS）、日本骨科协会（JOA）评分和改良 Macnab 标准。术后 1 周和 3 个月行 CT 检查观察通道愈合情况。
结果
平均手术时间为 83.75 分钟。无需引流管。无与手术相关的并发症发生。与术前评估相比，术后 VAS 和 JOA 评分均有所改善。末次随访时，根据改良 Macnab 标准，3 例疗效优良，1 例疗效良好。所有患者术后 MRI 均显示疝完全切除。术后随访期间未观察到修复物移位和钻孔椎体塌陷。术后 3 个月 CT 图像上可见骨通道几乎消失。
结论
这是首次在内镜下同时进行前路经椎体颈椎间盘切除术和 CR。通过这种方法可以减少对椎间盘和保留的颈椎运动节段的损伤。这是一种可行、安全、微创的手术。
试验注册号
ChiCTR1800016383。注册日期：2018 年 5 月 29 日。回顾性注册。
试验注册机构
中国临床试验注册中心。
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