摘要
目的探讨开放入路(空气/水介质)内镜辅助下颈椎前路间盘切除减压融合术(MOEA-ACDF)治疗脊髓型颈椎病(CSM)的疗效及安全性。方法随访研究。回顾性分析2021年1至12月在河南省直第三人民医院采用MOEA-ACDF治疗的30例CSM患者的临床资料。其中男20例,女10例,年龄(49.8±9.3)岁(28~70岁);C_(3~4)节段2例,C_(4~5)节段3例,C_(5~6)节段22例,C_(6~7)节段3例。比较术前和末次随访时患者日本骨科协会(JOA)评分、C_(2~7) Cobb角、手术节段前柱高度;记录术后并发症发生情况;评估椎前软组织水肿和积水情况;评估术后植骨融合率;计算末次随访时JOA评分改善优良率。结果所有患者手术顺利并获得随访,随访时间(12.7±2.7)个月(9~20个月);手术时间(85.3±11.0)min(65~110 min);术后引流量(16.7±7.4)ml(5~35 ml)。患者末次随访时JOA评分和C_(2~7) Cobb角均较术前改善[分别为(15.3±1.3)分比(12.2±2.3)分、15.5°±6.1°比12.3°±6.0°,均P<0.001]。末次随访时手术节段前柱高度较术前增高[(35.6±2.5)mm比(34.1±2.4)mm,P<0.001]。术后无吞咽困难、声音嘶哑、脑脊液漏、神经损伤、椎管内血肿等并发症发生;术后复查颈椎MRI时,发现3例患者椎前软组织水肿和积水,未出现明显症状;末次随访时通过颈椎X线或CT评估,融合节段均达到骨性融合标准,融合率100%。末次随访时,无神经症状加重、内固定失败、融合器下沉、邻近节段退变等并发症发生。末次随访时根据JOA评分改善优良率评定综合疗效:优19例,良8例,中3例,优良率90.0%(27/30)。结论MOEA-ACDF将内镜系统与ACDF技术相结合治疗CSM,可获得满意疗效,同时可有效恢复颈椎椎间高度和生理曲度,并具有较高的安全性。
Objective To investigate the efficacy and safety of mini open(air/water medium)endoscopy assisted anterior cervical discectomy and fusion(MOEA-ACDF)for the treatment of cervical spondylotic myelopathy(CSM).Methods A follow-up study.The clinical data of 30 patients with CSM treated by MOEA-ACDF from January to December in 2021 in the Henan NO.3 Provincial People′s Hospital were retrospectively analyzed.Of the patients,20 were male and 10 were female,the mean age was(49.8±9.3)years(ranged 28-70 years).The CSM occurred at C_(3-4) level in 2 cases,at C_(4-5) level in 3 cases,at C_(5-6) level in 22 cases and at C_(6-7) level in 3 cases.Each case was compared at the moment of pre-operation and final follow-up by the Japanese Orthopedic Association(JOA)score,C_(2-7) Cobb angle,and anterior column height of surgical segment.The postoperative complications were recorded.Prevertebral soft tissue edema and hydrops were assessed.The fusion rate was evaluated.The JOA improvement rate was computed at the final follow-up.Results All the operations were successfully completed and all the patients received follow-up for(12.7±2.7)months(ranged 9-20 months).The mean operation time was(85.3±11.0)min(ranged 65-110 min).The postoperative drainage volume was(16.7±7.4)ml(ranged 5-35 ml).The JOA score and the C_(2-7) Cobb angle both improved at the final follow-up when compared with those before the operation(15.3±1.3 vs 12.2±2.3,15.5°±6.1°vs 12.3°±6.0°,both P<0.001).The anterior column height of surgical segment at the final follow-up was(35.6±2.5)mm,and it was higher than that before the operation[(34.1±2.4)mm](P<0.001).No postoperative complications such as dysphagia,hoarseness,cerebrospinal fluid leakage,nerve injury,hematoma occurred.Postoperative review of cervical MRI revealed 3 cases of prevertebral soft tissue edema and hydrops without obvious symptoms.At the final follow-up,cervical spine X-ray or CT showed that all fusion segments met the criteria for osseous fusion,and the fusion rate was 100%.No complications such as neurological aggravation,internal fixation failure,fusion cage sinking,and adjacent segment degeneration was recorded at the final follow-up.At the final follow-up,the comprehensive efficacy evaluated by JOA improvement rate indicated the excellent and good rate was 90.0%(27/30):19 cases got an excellent outcome,8 cases got good and 3 cases got medium outcome.Conclusion MOEA-ACDF combines the endoscopic system with ACDF technology in the treatment of CSM can achieve satisfactory clinical efficacy with high safety,and effectively restore the cervical intervertebral height and physiological curvature.
作者
杨贺军
简磊
唐骞
王宇鹏
马草源
刘洋
牛旺
Yang Hejun;Jian Lei;Tang Qian;Wang Yupeng;Ma Caoyuan;Liu Yang;Niu Wang(Department of Intervertebral Disc Center,Henan NO.3 Provincial People′s Hospital,Zhengzhou 450000,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第35期2795-2800,共6页
National Medical Journal of China
基金
河南省医学科技攻关计划(联合共建)项目(LHGJ20190859)
关键词
颈椎
脊髓型颈椎病
脊柱内镜
颈椎前路间盘切除减压融合术
Cervical vertebrae
Cervical spondylotic myelopathy
Spinal endoscopy
Anterior cervical discectomy and fusion
作者简介
通信作者:杨贺军,Email:hjyang@163.com
