颈椎管狭窄症伴椎间孔及（或）侧隐窝狭窄所致神经根型颈椎病后路经皮颈椎内镜下前路减压与单纯后路减压治疗的对比研究：一项临床回顾性研究。

A comparison study of posterior cervical percutaneous endoscopic ventral bony decompression and simple dorsal decompression treatment in cervical spondylotic radiculopathy caused by cervical foraminal and/or lateral spinal stenosis: a clinical retrospective study.

机构信息

Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province, China.

Department of Orthopedic Surgery, The Affiliated Hospital of Qingdao University, Shinan District, Qingdao, Shandong province, China.

出版信息

BMC Musculoskelet Disord. 2020 May 11;21(1):290. doi: 10.1186/s12891-020-03313-2.

DOI:10.1186/s12891-020-03313-2

PMID:32393314

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7216365/

Abstract

BACKGROUND

Percutaneous endoscopic cervical decompression (PECD) is an ideal minimally invasive decompression technique for the treatment of cervical spondylotic radiculopathy (CSR). However, the mainstream is the resection of dorsal bone and removal of free nucleus pulposus. The necessity of excision of ventral osteophytes and hyperplastic ligaments in the treatment of CSR caused by cervical foraminal and/or lateral spinal stenosis (CFa/oLSS) to be discussed.

METHODS

We performed a retrospective study of 46 patients with CSR caused by CFa/oLSS from January 2017 to November 2018. These patients received posterior percutaneous endoscopic cervical decompression-ventral bony decompression (PPECD-VBD)(23 cases, classified as VBD group) or posterior percutaneous endoscopic cervical decompression-simple dorsal decompression (PPECD-SDD)(23 cases, classified as SDD group). Following surgery, we recorded Visual Analogue Scale (VAS), Neck Disable Index (NDI), Japanese Orthopaedic Association (JOA) Scores and myodynamia. We further evaluated the changes of cervical curvature and cervical spine motion in the VBD group and recorded the operation time and complications during the follow-up of each patient.

RESULTS

All patients underwent successful operations, with an average follow-up time of 16.53 ± 9.90 months. The excellent and good rates in the VBD and SDD groups were 91.29 and 60.87%, respectively. In the SDD group, neck-VAS, arm-VAS, and NDI scores were significantly higher than those of the VBD group at 1 day, 6 months, and 12 months after surgery (P < 0.05), while the JOA scores and improvement rate of JOA were significantly lower than those of the VBD group (P < 0.05). There were no significant differences in terms of angular displacement (AD), horizontal displacement (HD), segmental angle (SA) and cervical curvature (CA) before and after the operation in the VBD group (P > 0.05).

CONCLUSION

PPECD-VBD was significantly better than PPECD-SDD as well as PPECD-VBD had no significant effects on cervical spine stability or cervical curvature.

摘要

背景

经皮内镜颈椎减压术（PECD）是治疗神经根型颈椎病（CSR）的一种理想的微创减压技术。然而，主流是切除背骨和游离髓核。需要讨论颈椎管狭窄症（CSR）治疗中颈孔和/或侧椎管狭窄（CFa/oLSS）时切除腹侧骨赘和增生的韧带的必要性。

方法

我们对 2017 年 1 月至 2018 年 11 月间因 CSR 而接受后路经皮内镜颈椎减压-腹侧骨减压（PPECD-VBD）（23 例，分为 VBD 组）或后路经皮内镜颈椎减压-单纯背侧减压（PPECD-SDD）（23 例，分为 SDD 组）的 46 例患者进行了回顾性研究。术后记录视觉模拟评分（VAS）、颈部残疾指数（NDI）、日本骨科协会（JOA）评分和肌力。进一步评估 VBD 组颈椎曲度和颈椎活动度的变化，并记录每位患者随访期间的手术时间和并发症。

结果

所有患者均顺利完成手术，平均随访时间为 16.53±9.90 个月。VBD 组和 SDD 组的优良率分别为 91.29%和 60.87%。SDD 组术后 1 天、6 个月和 12 个月的颈 VAS、臂 VAS 和 NDI 评分均显著高于 VBD 组（P<0.05），而 JOA 评分和 JOA 改善率均显著低于 VBD 组（P<0.05）。VBD 组术后颈椎曲度（CA）、角位移（AD）、水平位移（HD）、节段角（SA）与术前比较无统计学差异（P>0.05）。