中国修复重建外科杂志

中国修复重建外科杂志

经皮后路全内镜神经根管切开治疗骨性颈神经根管狭窄的手术设计及临床应用

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目的 设计经皮后路全内镜神经根管切开治疗骨性颈神经根管狭窄,并临床应用分析其可行性。 方法 2015 年 10 月—2017 年 6 月,将符合选择标准的 12 例骨性颈神经根管狭窄患者纳入研究。其中男 7 例,女 5 例;年龄 52~63 岁,平均 57.6 岁。病程 15 d~6 个月,平均 3.7 个月。病变节段:C4、5 2 例,C5、6 6 例,C6、7 4 例。临床表现为神经根卡压所致的根性疼痛或麻木。患者均行经皮后路全内镜神经根管切开减压术。术前、术后即刻及末次随访时采用疼痛视觉模拟评分(VAS)及颈椎功能障碍指数(NDI)评估患者上肢与颈部疼痛缓解程度;末次随访时采用改良 Macnab 评分标准评估临床疗效。 结果 患者均顺利完成手术,手术时间 71~105 min,平均 82 min;术中出血量约 5 mL。术后 1 周复查颈椎 CT 示颈神经根管扩大,神经根受压解除。术后患者颈部及上肢疼痛、麻木等症状明显缓解,住院时间 2~5 d,平均 3 d。12 例患者均获随访,随访时间 6~18 个月,平均 12.3 个月。除 1 例患者术后存在短暂感觉减退外,余均无血肿、神经根损伤及切口感染等并发症发生。术后即刻及末次随访时 VAS 评分及 NDI 均较术前显著改善,末次随访时较术后即刻亦有显著改善,差异均有统计学意义(P<0.05)。末次随访时采用改良 Macnab 标准评价临床疗效,获优 9 例、良 2 例、可 1 例,优良率 91.7%。 结论 经皮后路全内镜神经根管切开能顺利完成骨性颈神经根管狭窄减压,以微创方法获得较好的临床疗效,是一种安全、可行的方法。

Objective To design the method of posterior percutaneous full-endoscopic cervical foraminotomy (P-PECF) for treating cervical osseous foraminal stenosis and analyze its feasibility in clinical application. Methods The clinical data of 12 patients with cervical osseous foraminal stenosis who met the selection criteria between October 2015 and June 2017 were retrospectively analysed. There were 7 males and 5 females with an age of 52-63 years (mean, 57.6 years). The disease duration ranged from 15 days to 6 months (mean, 3.7 months). The segments included C4, 5 in 2 cases, C5, 6 in 6 cases, and C6, 7 in 4 cases; all showing root pain or numbness caused by nerve root compression. All the patients received the P-PECF technique in a prone position and received general anesthesia. At preoperation, immediately after operation, and at last follow-up, visual analogue scale (VAS) scores and neck disability index (NDI) were respectively recorded to assess the patient’s quality of life and the pain of neck and arm. The clinical outcomes were evaluated by the modified Macnab criteria. Results All operations were successful. The operation time was 71-105 minutes (mean, 82 minutes); the intraoperative blood loss was about 5 mL. The CT of the cervical spine at 1 week postoperatively showed that the cervical root canal was enlarged and the nerve root compression was relieved. Postoperative neck and arm pain, numbness were relieved; the hospitalization time was 2-5 days (mean, 3 days). All patients were followed up 6-18 months (mean, 12.3 months). Except for 1 patient’s feeling transient hypoesthesia postoperatively, there was no complication such as hematoma, nerve root injury, or incision infection. The VAS scores and NDI at immediate postoperatively and at last follow-up were significantly improved when compared with preoperative scores (P<0.05); and the scores also improved significantly at last follow-up when compared with the scores at immediate postoperatively (P<0.05). According to modified Macnab criteria, the results were excellent in 9 cases, good in 2 cases, and fair in 1 case, with an excellent and good rate of 91.7%. Conclusion The P-PECF technique can enlarge the nerve root canal and relieve nerve root compression, and obtain better effectiveness by minimally invasive methods. It is a safe and feasible procedure.

关键词: 颈椎; 全内镜; 神经根管狭窄; 微创

Key words: Cervical vertebrae; full-endoscopy; osseous foraminal stenosis; minimally invasive

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