Department of Mini-Invasive Spinal Surgery, Third Hospital of Henan Province, Zhengzhou, China.
Orthop Surg. 2022 May;14(5):876-884. doi: 10.1111/os.13237. Epub 2022 Apr 19.
OBJECTIVE: To compare the clinical efficacy of posterior percutaneous endoscopic unilateral laminotomy (PPEUL) and anterior cervical decompression and fusion (ACDF) in the treatment of single-segment spondylotic myelopathy (CSM). METHODS: This is a retrospective research, from January 2017 to December 2019, 30 cases were included in the PPEUL group and 32 cases were included in the ACDF group. The operative duration, blood loss, length of stay, complications, Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, MacNab classification and imaging data were collected preoperatively, postoperative 1-week, final follow-up and statistically analyzed. RESULTS: The surgery was completed successfully on all patients, and there were no serious complications, such as nerve or spinal cord injury or infection. In the PPEUL and ACDF groups, the operative duration were 56.63 ± 1.40 and 65.21 ± 2.45 min, the intraoperative blood loss were 51.69 ± 3.23 and 50.51 ± 5.48 mL, and the hospitalization duration was 5.75 ± 1.43 and 6.38 ± 2.16 days. The follow-up period in the PPEUL and ACDF groups was 24.96 ± 1.12 months and 25.65 ± 1.45 months, respectively. There was no significant difference in intraoperative blood loss between the two groups, but the hospitalization and operative durations in the PPEUL group were significantly shorter than those in the ACDF group (P < 0.05). The VAS scores at postoperative 1 week and final follow-up were significantly improved compared with those before surgery. The JOA scores at postoperative 1 week and final follow-up were significantly improved compared with those before surgery, but there was no significant difference between the two groups at the last follow-up. The intervertebral disc height of the adjacent segment at the last follow-up was significantly lower in the ACDF group than in the PPEUL group (P < 0.05), but there was no significant difference between the two groups in the intervertebral disc height of the surgical segment (P > 0.05). The rate of excellent and good results was 90.0% and 87.5%, respectively. Postoperative cervical CT and MRI showed that the spinal canal was fully decompressed and spinal cord compression was relieved. CONCLUSION: PPEUL has the advantages of reduced trauma, rapid recovery and remarkable curative efficacy, so it is a new choice for the treatment of CSM.
目的：比较后路经皮内镜单侧椎板切除术（PPEUL）与前路颈椎减压融合术（ACDF）治疗单节段脊髓型颈椎病（CSM）的临床疗效。
方法：本研究为回顾性研究，纳入 2017 年 1 月至 2019 年 12 月期间的 30 例 PPEUL 组患者和 32 例 ACDF 组患者。收集两组患者的手术时间、术中出血量、住院时间、并发症、日本骨科协会（JOA）评分、视觉模拟评分（VAS）、MacNab 分级和影像学资料，分别于术前、术后 1 周、末次随访进行统计学分析。
结果：所有患者均顺利完成手术，无神经或脊髓损伤、感染等严重并发症。在 PPEUL 组和 ACDF 组中，手术时间分别为 56.63±1.40min 和 65.21±2.45min，术中出血量分别为 51.69±3.23mL 和 50.51±5.48mL，住院时间分别为 5.75±1.43d 和 6.38±2.16d。PPEUL 组和 ACDF 组的随访时间分别为 24.96±1.12 个月和 25.65±1.45 个月。两组患者术中出血量无显著差异，但 PPEUL 组的住院时间和手术时间均明显短于 ACDF 组（P<0.05）。术后 1 周和末次随访时 VAS 评分均较术前显著改善，术后 1 周和末次随访时 JOA 评分均较术前显著改善，但末次随访时两组间无显著差异。末次随访时 ACDF 组相邻节段椎间盘高度明显低于 PPEUL 组（P<0.05），但两组手术节段椎间盘高度无显著差异（P>0.05）。术后优良率分别为 90.0%和 87.5%。术后颈椎 CT 和 MRI 显示椎管充分减压，脊髓压迫缓解。
结论：PPEUL 具有创伤小、恢复快、疗效显著等优点，是治疗 CSM 的一种新选择。
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