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颈椎侧路椎间孔镜手术与全内镜下颈椎侧路椎间孔镜手术治疗神经根型颈椎病的疗效比较。

Comparison of the Outcomes of Microendoscopic Cervical Foraminotomy versus Full-endoscopic Cervical Foraminotomy for the Treatment of Cervical Radiculopathy.

机构信息

Department of Orthopaedics, Iwai Orthopaedic Medical Hospital.

Department of Orthopaedics, Cedars Sinai Marina Del Rey Hospital.

出版信息

Neurol Med Chir (Tokyo). 2023 Sep 15;63(9):426-431. doi: 10.2176/jns-nmc.2023-0073. Epub 2023 Jul 10.

Abstract

This study aimed to compare the outcomes of microendoscopic cervical foraminotomy (MECF) versus full-endoscopic cervical foraminotomy (FECF) for treating cervical radiculopathy (CR).A retrospective study was performed on patients with CR treated using MECF (n = 35) or FECF (n = 89). A 16-mm tubular retractor and endoscope was used for MECF, while a 4.1-mm working channel endoscope was used for FECF. Patient background and operative data were collected. The numerical rating scale (NRS) and the Neck Disability Index scores were recorded preoperatively and at 1 year postoperatively. Postoperative subjective satisfaction was also assessed.Although the NRS, and NDI scores, as well as postoperative satisfaction at 1 year considerably improved in both groups, one of the background data (number of operated vertebral level) was significantly different. Therefore, we separately analyzed single- and two-level CR. In single-level CR, operation time, intraoperative bleeding, postoperative stay, NDI after 1 year, and reoperation rate were statistically superior in FECF group. In two-level CR, the postoperative stay was statistically superior in FECF group. Three postoperative hematomas were observed in the MECF group, while none was observed in the FECF group.Operative outcomes did not significantly differ between groups. We did not observe postoperative hematoma in FECF even without placement of a postoperative drain. Therefore, we recommend FECF as the first option for the treatment of CR as it has a better safety profile and is minimally invasive.

摘要

本研究旨在比较显微镜下颈椎侧方减压术(MECF)与全内镜下颈椎侧方减压术(FECF)治疗神经根型颈椎病(CR)的疗效。回顾性分析了接受 MECF(n=35)或 FECF(n=89)治疗的 CR 患者。MECF 采用 16mm 管状牵开器和内镜,FECF 采用 4.1mm 工作通道内镜。收集患者的背景资料和手术数据。记录术前和术后 1 年的数字评分量表(NRS)和颈椎残障指数(NDI)评分,并评估术后主观满意度。虽然两组患者的 NRS、NDI 评分以及术后 1 年的满意度均显著改善,但其中一项背景数据(手术节段数)存在显著差异。因此,我们分别对单节段和双节段 CR 进行了分析。在单节段 CR 中,FECF 组在手术时间、术中出血量、术后住院时间、术后 1 年 NDI 和再次手术率方面具有统计学优势。在双节段 CR 中,FECF 组在术后住院时间方面具有统计学优势。MECF 组有 3 例术后血肿,而 FECF 组无术后血肿。两组患者的手术效果无显著差异。我们发现 FECF 组即使不放置术后引流也没有发生术后血肿,因此具有更好的安全性。因此,我们建议将 FECF 作为治疗 CR 的首选方法,因为它具有更好的安全性和微创性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f44b/10556212/07150a3fd62d/1349-8029-63-0426-g001.jpg

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