全内镜椎板切开减压术与前路颈椎间盘切除融合术治疗单节段颈椎椎管狭窄症的回顾性、倾向评分匹配研究。

OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) is the standard procedure for the treatment of cervical spinal stenosis (CSS), but complications such as adjacent segment degeneration can seriously affect the long-term efficacy. Currently, posterior endoscopic surgery has been increasingly used in the clinical treatment of CSS. The aim of this study was to compare the clinical outcomes of single-segment CSS patients who underwent full endoscopic laminotomy decompression or ACDF. METHODS: 138 CSS patients who met the inclusion criteria from June 2018 to August 2020 were retrospectively analyzed and divided into endoscopic and ACDF groups. The propensity score matching (PSM) method was used to adjust the imbalanced confounding variables between the groups. Then, perioperative data were recorded and clinical outcomes were compared, including functional scores and imaging data. Functional scores included Visual Analog Scale of Arms (A-VAS) and Neck pain (N-VAS), Japanese Orthopedic Association score (JOA), Neck Disability Index (NDI), and imaging data included Disc Height Index (DHI), Cervical range of motion (ROM), and Ratio of grey scale (RVG). RESULTS: After PSM, 84 patients were included in the study and followed for 24-30 months. The endoscopic group was significantly superior to the ACDF group in terms of operative time, intraoperative blood loss, incision length, and hospital stay (P < 0.001). Postoperative N-VAS, A-VAS, JOA, and NDI were significantly improved in both groups compared with the preoperative period (P < 0.001), and the endoscopic group showed better improvement at 7 days postoperatively (P < 0.05). The ROM changes of adjacent segments were significantly larger in the ACDF group at 12 months postoperatively and at the last follow-up (P < 0.05). The RVG of adjacent segments showed a decreasing trend, and the decrease was more marked in the ACDF group at last follow-up (P < 0.05). According to the modified MacNab criteria, the excellent and good rates in the endoscopic group and ACDF group were 90.48% and 88.10%, respectively, with no statistically significant difference (P > 0.05). CONCLUSION: Full endoscopic laminotomy decompression is demonstrated to be an efficacious alternative technique to traditional ACDF for the treatment of single-segment CSS, with the advantages of less trauma, faster recovery, and less impact on cervical spine kinematics and adjacent segmental degeneration.

目的：颈椎前路椎间盘切除融合术（ACDF）是治疗颈椎管狭窄症（CSS）的标准方法，但邻近节段退变等并发症会严重影响长期疗效。目前，后路内镜手术已越来越多地应用于 CSS 的临床治疗。本研究旨在比较接受全内镜椎板切开减压术或 ACDF 的单节段 CSS 患者的临床疗效。

方法：回顾性分析 2018 年 6 月至 2020 年 8 月符合纳入标准的 138 例 CSS 患者，将其分为内镜组和 ACDF 组。采用倾向评分匹配（PSM）方法调整组间不均衡的混杂变量，记录围手术期数据并比较临床疗效，包括功能评分和影像学数据。功能评分包括手臂视觉模拟评分（A-VAS）和颈部疼痛（N-VAS）、日本骨科协会评分（JOA）、颈部残疾指数（NDI），影像学数据包括椎间盘高度指数（DHI）、颈椎活动度（ROM）和灰度比（RVG）。

结果：PSM 后，84 例患者纳入研究并随访 24-30 个月。与 ACDF 组相比，内镜组在手术时间、术中出血量、切口长度和住院时间方面具有显著优势（P<0.001）。两组术后 N-VAS、A-VAS、JOA 和 NDI 均较术前明显改善（P<0.001），术后 7 天内镜组改善更明显（P<0.05）。术后 12 个月和末次随访时 ACDF 组邻近节段 ROM 变化明显更大（P<0.05）。邻近节段的 RVG 呈下降趋势，末次随访时 ACDF 组下降更为明显（P<0.05）。根据改良 MacNab 标准，内镜组和 ACDF 组的优良率分别为 90.48%和 88.10%，差异无统计学意义（P>0.05）。

结论：全内镜椎板切开减压术是治疗单节段 CSS 的一种有效替代传统 ACDF 的方法，具有创伤小、恢复快、对颈椎运动学和邻近节段退变影响小等优点。