颈后路脊柱内镜治疗神经根型颈椎病的1年随访研究

THE CLINCAL OUTCOME OF POSTERIOR CERVICAL ENDOSCOPIC DISCECTOMY ON THE PAIENTS WITH CERVICAL SPONDYLOTIC RADICULOPATHY: A 1-YEAR FOLLOW-UP

摘要:

目的：探索颈后路脊柱内镜治疗神经根型颈椎病(Cervical Spondylotic Radiculopathy,CSR)的安全性和术后疗效。方法：纳入“神经根型颈椎病”诊断明确并于2017年1月至2018年10月在我科接受颈后路脊柱内镜手术治疗的患者68例,术后随访1年,记录所有患者性别、年龄、疼痛持续时间、手术节段、手术时间、术中并发症、住院天数等。采用数字疼痛评分(numeric rating scales,NRS)评估疼痛(0-10),Oswestry功能障碍指数(oswestry disability index,ODI)(0-100)和日本骨科协会评估治疗分数(Japanese Orthopaedic association scores,JOA)(0-17分)评估术后功能恢复,记录患者术前、术后1天、7天、1月、3月、6月和1年颈肩部和上肢NRS疼痛评分,以及ODI和JOA评估结果,在术后1年随访中采用改良Macnab评估患者临床预后。结果：68例患者中男性36例、女性32例,平均年龄55.4 ± 11.2岁,疼痛持续平均时间为114.5 ± 23.5周。手术节段为C3-4 4例、C4-5 15例、C5-6 36例、C6-7 12例、C5-6和C6-7 1例,手术平均时间为78.1 ± 9.6分钟,平均住院天数为4.3 ± 1.6天。所有患者完成术后1年临床随访。术后各时间点颈肩部和上肢疼痛NRS评分较术前显著降低(P?0.01),术后ODI指数也显著低于术前(P?0.01)。68例患者中有38例为“优”、20例“良”、9例“可”、1例“差”,“优良率”达85.3%。无患者术中发生神经根损伤、硬膜囊撕裂或感染等并发症,或在因症状复发需要接受二次微创或开放手术治疗。结论：颈后路脊柱内镜为治疗CSR的一种有效且安全的手术方式,可有效改善症状和患者生活质量,但由于本研究的局限性,结论需要未来随机对照的大样本研究进一步证实。

Abstract:

Objective: The study is aiming to explore the long-term clinical outcome of posterior cervical endoscopic discectomy on the patients with cervical spondylotic radiculopathy (CSR). Methods: Totally 68 patients diagnosed with CSR and received posterior cervical endoscopic discectomy in the department of Pain Medicine of the Second Affiliated Hospital of Wenzhou Medical University during January 2017 and October 2019 were enrolled. The information of all patients of sex, age, pain duration, surgery level, operation time, complication and hospital stay were recorded. The numeric rating scales (NRS) (0-10), Oswestry Disability Index (ODI) (0-100) and Japanese Orthopaedic association scores (JOA) were adopted to assess the pain and dysfunction of patients at pre-operation, postoperative 1-day, 7-day, 1-month, 3-month, 6-month and 1-year. In addition, modified Macnab was used to evaluate the prognosis of the patients at the last visit. Results: There were 36 males and 32 females, and the average age was 55.4 ± 11.2 years, the average pain duration was 114.5 ± 23.5 weeks. The operation level of 4 cases was on C3-4, 15 cases on C4-5, 36 cases on C5-6, 12 cases on C6-7 and 1 case on C5-6 and C6-7. The average operation time was 78.1 ± 9.6 mins, the hospital stay was 4.3 ± 1.6 days. All patients finished postoperative 1-year follow up. Compared with pre-operation, the NRS pain rating of the postoperative neck and shoulder pain, and upper limb pain were significantly decreased at all postoperative follow up time points (P?0.01). The ODI scores were also reduced after the operation treatment at all time points compared with pre-operation (P?0.01). There were 38 cases evaluated with “excellent”, 20 cases were “good”, 9 cases were “fair” and 1 case were “poor”, therefore, the satisfactory rate was 85.3%. No nerve root injury, epidural tear or infection was reported, and no spinal instability occurred and no patients needed a second surgery treatment because of recurrence. Conclusion: The posterior cervical endoscopic discectomy was demonstrated to be an effective and safe therapy of CSR, which can significantly improve pain with a good clinical outcome. However, due to the limitation of this study, further randomized with larger sample study was also needed to make a confirmative conclusion.