Department of Orthopedics Surgery, Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi, 563000, Guizhou, China.
Department of Orthopedics Surgery, The Second Affiliated Hospital of Zunyi Medical University, No.1 Xinpu Road, Zunyi, 563000, Guizhou, China.
J Orthop Surg Res. 2020 Sep 4;15(1):381. doi: 10.1186/s13018-020-01920-2.
Percutaneous spinal endoscopy is a new type of surgery for the treatment of cervical disc herniation. It can avoid the complications of the classic anterior cervical discectomy and fusion (ACDF) approach and the risk of adjacent spondylosis. How can we effectively improve patients' awareness of spinal endoscopy and their election of endoscopic techniques?
To analyze the compliance and clinical effect of the integrated management of the whole process in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation.
Retrospective analysis of 72 patients with cervical disc herniation undergoing surgery in our hospital from August 2015-August 2017 was performed. The whole-process integrated management model was used for all the patients. The 36 patients in the experimental group were treated by percutaneous full-endoscopic cervical discectomy, and the 36 patients in the control group were treated by ACDF. The postoperative feeding time, time to get out of bed, length of hospital stay, compliance, clinical efficacy, and recurrence rate of neck pain were observed. Changes between the preoperative and postoperative pain visual analog scale (VAS) scores and neurological function Japan Orthopaedic Association (JOA) scores were assessed.
The postoperative feeding time in the experimental group was 8.319 ± 1.374 h, the postoperative time to get out of bed was 16.64 ± 3.728 h, and the hospitalization time was 6.403 ± 0.735 days. The excellent and good clinical efficacy rate was 91.67%, the compliance rate was 88.89%, and the neck pain recurrence rate was 5.56%. The postoperative feeding time in the control group was 26.56 ± 9.512 h, the postoperative time to get out of bed was 45.06 ± 9.027 h, and the length of hospital stay was 8.208 ± 0.865 days. The excellent and good clinical efficacy rate was 88.89%, the compliance rate was 69.4%, and the neck pain recurrence rate was 8.33%. There was no significant difference between the two groups in the excellent efficacy rate and the neck pain recurrence rate, p > 0.05. The compliance rate in the experimental group was better than that in the control group, and the difference was statistically significant, p < 0.05. The hospitalization time of the experimental group was significantly lower than that of the control group, and the difference was statistically significant, p < 0.05. The postoperative VAS scores and JOA scores of the two groups were significantly better than the preoperative scores, and the difference was statistically significant, p < 0.05; there was no significant difference between the two groups, p > 0.05.
The integrated management of the whole course can effectively improve the compliance of patients with cervical disc herniation receiving endoscopic treatment, yield the same treatment effect as the classic operation, shorten the hospitalization time, speed up the turnover of hospital beds, and improve satisfaction with medical quality and is worthy of clinical application.
经皮脊柱内窥镜技术是一种治疗颈椎间盘突出症的新型手术方式，它可以避免经典的前路颈椎间盘切除融合术（anterior cervical discectomy and fusion，ACDF）的并发症和临近节段病变的风险。如何有效提高患者对脊柱内窥镜的认识，使其选择内镜技术？
分析颈椎间盘突出症患者经皮全内窥镜手术选择中全程综合管理的依从性和临床效果。
回顾性分析 2015 年 8 月至 2017 年 8 月我院收治的 72 例颈椎间盘突出症患者，所有患者均采用全程综合管理模式，实验组 36 例患者采用经皮全内窥镜下颈椎间盘切除术治疗，对照组 36 例患者采用 ACDF 治疗。观察两组患者术后进食时间、下床时间、住院时间、依从性、临床疗效、颈部疼痛复发率，评估术前、术后疼痛视觉模拟量表（visual analog scale，VAS）评分和日本骨科协会（Japanese Orthopaedic Association，JOA）评分变化。
实验组术后进食时间为 8.319±1.374 h，术后下床时间为 16.64±3.728 h，住院时间为 6.403±0.735 d。实验组优良率为 91.67%，依从率为 88.89%，颈部疼痛复发率为 5.56%。对照组术后进食时间为 26.56±9.512 h，术后下床时间为 45.06±9.027 h，住院时间为 8.208±0.865 d。对照组优良率为 88.89%，依从率为 69.4%，颈部疼痛复发率为 8.33%。两组优良率及颈部疼痛复发率比较差异均无统计学意义（P>0.05），实验组依从率优于对照组，差异有统计学意义（P<0.05），实验组住院时间明显低于对照组，差异有统计学意义（P<0.05）。两组术后 VAS 评分和 JOA 评分均明显优于术前，差异有统计学意义（P<0.05），两组间比较差异无统计学意义（P>0.05）。
全程综合管理可有效提高颈椎间盘突出症患者内镜治疗的依从性，获得与经典手术相同的治疗效果，缩短住院时间，加快病床周转，提高对医疗质量的满意度，值得临床应用。
