全内镜下前路经椎体入路治疗颈椎间盘突出症的中期随访结果

发布时间：2018-11-06 17:30

【摘要】：目的:探讨全内镜下前路经椎体颈椎间盘切除术(Full-endoscopic Anterior Transcorporeal Cervical Discectomy,FEATCD)治疗颈椎间盘突出症的中期随访结果,包括临床结果及影像学结果。方法:选择自2015年9月至2016年2月18例行FEATCD的单节段颈椎间盘突出症的病人。其中男女患者分别为11例和7例,平均年龄54±12.24岁(范围:38-76岁),症状持续时间平均为12.56±9.93周(范围:2-23周),病变节段分别为C3/4 4例、C4/5 7例、C5/6 7例。平均随访时间12-18个月,平均14.44±2.18月。临床结果分别采用视觉模拟评分(Visual Analog Scale,VAS)、日本骨科医师协会评分(Japanese Orthopaedic Association Scores,JOA)及Nurick分级对患者进行评估。影像学随访包括术前术后颈椎正侧位片、计算机断层摄影技术(Computed Tomography,CT)及磁共振成像技术(Magnetic Resonance Imaging,MRI)。侧位片用于术后测定椎间隙高度(Intervertebral Disc Height,IDH)及脊柱功能单位(Functional Spinal Unit,FSU)的高度。动力位片用于评估是否存在椎间不稳定。CT用于观察术后通道建立情况及通道愈合情况。MRI用于查看术后减压情况。结果:所有手术均由同一术者顺利完成。平均手术时间为69.83±16.68min。平均出血量12.56±5.69ml。所有病人术后均无需放置引流管。所有患者的颈部及上肢疼痛症状术后均获得了立即缓解。末次随访时VAS与JOA评分均得到了明显的改善,颈部及上肢的平均VAS分别从术前的6.19±2.08和5.25±2.87降至术后的1.58±1.42和0.97±0.65(P0.05)。术前及末次随访平均JOA评分分别为9.13±1.95和15.17±0.75(P0.05)。平均改善率(Improvement Rate of JOA,IR)为78.19±10.23%。术前及末次随访的平均Nurick分级分别为2.5和0.42。术前与末次随访的椎间隙高度分别为5.49±0.52mm和5.14±0.56mm(P0.05),FSU高度分别33.83±2.53mm和32.67±2.50mm(P0.05)。未发现手术相关并发症。结论:全内镜下前路经椎体技术进行突出颈椎间盘切除是一种相对较新颖的技术,手术避免了椎体间融合,保留了颈椎运动节段,最大限度的降低了椎间盘损伤,而且创伤小、费用低,病人更易接受。但是FEATCD广泛开展之前尚需大样本资料进行更长时间的随访,明确此术式是否会存在远期椎间隙高度降低、椎间不稳及椎间自发融合等并发症。
[Abstract]:Objective: to investigate the clinical and imaging results of endoscopic anterior cervical discectomy (Full-endoscopic Anterior Transcorporeal Cervical Discectomy,FEATCD) in the treatment of cervical disc herniation. Methods: from September 2015 to February 2016, 18 FEATCD patients with single cervical disc herniation were selected. The mean age was 54 卤12.24 years (range: 38-76 years). The mean duration of symptoms was 12.56 卤9.93 weeks (range: 2-23 weeks). C 5 / 67 cases. The mean follow-up time was 12-18 months (14. 44 卤2. 18 months). The clinical results were evaluated by visual analogue score (Visual Analog Scale,VAS), Japanese orthopedic physicians Association (Japanese Orthopaedic Association Scores,JOA) and Nurick grade. Imaging follow-up included anterior and lateral cervical radiography, computed tomography (Computed Tomography,CT) and magnetic resonance imaging (Magnetic Resonance Imaging,MRI). Lateral radiographs were used to measure the height of intervertebral space (Intervertebral Disc Height,IDH) and spinal functional unit (Functional Spinal Unit,FSU) after operation. Dynamic position radiographs were used to assess the presence of intervertebral instability. CT was used to observe the establishment and healing of the channels after operation. MRI was used to examine the decompression after surgery. Results: all the operations were performed successfully by the same operator. The mean operative time was 69.83 卤16.68 min. The average bleeding volume was 12.56 卤5.69 ml. Drainage tubes were not required in all patients after operation. All patients with neck and upper limb pain symptoms were immediately relieved. At the last follow-up, the scores of VAS and JOA were significantly improved. The average VAS of neck and upper limb decreased from 6.19 卤2.08 and 5.25 卤2.87 to 1.58 卤1.42 and 0.97 卤0.65 respectively (P0.05). The mean JOA scores were 9.13 卤1.95 and 15.17 卤0.75, respectively (P0.05). The average improvement rate (Improvement Rate of JOA,IR) was 78.19 卤10.23. The mean Nurick scores of preoperative and last follow-up were 2. 5 and 0. 42, respectively. The height of intervertebral space was 5.49 卤0.52mm and 5.14 卤0.56mm (P0.05), FSU height 33.83 卤2.53mm and 32.67 卤2.50mm respectively, P0.05). No surgical complications were found. Conclusion: total endoscopic anterior cervical discectomy is a relatively new technique, which avoids interbody fusion, preserves cervical motor segment and minimizes the injury of intervertebral disc. The lower the cost, the easier it is for the patient. However, large sample data are needed for longer follow-up before FEATCD is widely carried out. It is clear whether this procedure will have complications such as reduction of intervertebral space height, intervertebral instability and spontaneous fusion of vertebrae.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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