低温等离子髓核消融术与内镜下颈椎间盘髓核摘除术治疗颈椎病的疗效对比

胡军; 王梓; 郭雨雨; 韩刘虎; 陈立洋; 王立奎

doi:10.16766/j.cnki.issn.1674-4152.003540

低温等离子髓核消融术与内镜下颈椎间盘髓核摘除术治疗颈椎病的疗效对比

doi: 10.16766/j.cnki.issn.1674-4152.003540

安徽医科大学第一附属医院疼痛科，安徽合肥 230022

基金项目:

国家自然科学基金项目 81901086

详细信息

通讯作者:
胡军，E-mail：hujund@139.com

中图分类号: R681.55 R687.4
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- 被引次数: 0
出版历程
- 收稿日期: 2023-12-09
- 网络出版日期: 2024-07-22

Comparative on the efficacy of percutaneous cervical nucleoplasty and posterior endoscopic cervical discectomy for cervical spondylotic radiculopathy

Department of Pain Medicine, the Frist Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China

摘要

摘要: 目的探讨经皮颈椎低温等离子髓核消融术(PCN)与后路经皮内镜下颈椎间盘髓核摘除术(PPECD)治疗神经根型颈椎病的临床效果。方法选取安徽医科大学第一附属医院疼痛科2019年5月—2021年6月治疗的67例包容型单节段颈椎间盘软性突出患者，根据手术方法分为PPECD组(35例)和PCN组(32例)。于术前、术后多个时间点分别通过VAS评分评价疼痛变化情况，颈椎功能障碍指数(NDI)评估颈椎功能恢复情况；术后1年随访，采用改良的MacNab标准评估手术疗效。结果 2组患者均顺利完成手术，且术后随访记录完整。2组患者术前一般资料比较差异无统计学意义。PCN组手术时间[(42.0±6.4)min]明显短于PPECD组[(94.7±6.3)min，P＜0.001]。与术前相比，2组患者术后各时间点疼痛评分和颈椎功能障碍指数均显著改善(P＜0.05)。根据MacNab标准，PPECD组患者治疗优良率(82.9%，29/35)高于PCN组(75.0%，24/32)，但差异无统计学意义(P＞0.05)。2组患者均未观察到严重的术后并发症。结论就手术耐受较差的患者而言，PCN可成为包容型单节段颈椎间盘软性突出的神经根型颈椎病患者行PPECD治疗的良好替代方案。
- 神经根型颈椎病 /
- 颈椎间盘突出 /
- 低温等离子髓核消融术 /
- 后路经皮内镜下颈椎间盘髓核摘除术
Abstract: Objective To explore the clinical effects of percutaneous cervical nucleoplasty (PCN) and posterior percutaneous endoscopic cervical discectomy (PPECD) in the treatment of cervical spondylotic radiculopathy. Methods Sixty-seven cases of cervical spondylotic radiculopathy due to a single-level contained soft-disc herniation in the Department of Pain Medicine of the First Affiliated Hospital of Anhui Medical University from May 2019 to June 2021 were selected, and divided into Group PPECD (n=35) and Group PCN (n=32) according to surgical methods. Pain was assessed by VAS scores at multiple time points before and after surgery, and cervical functional recovery was evaluated using the cervical dysfunction index (NDI). The modified MacNab criteria were used to evaluate the surgical efficacy at the final follow-up. Results All patients completed the surgery and had complete follow-up data. There was no significant difference in the general preoperative conditions of the two groups of patients. The operation time of PCN treatment [(42.0±6.4) min] was significantly shorter than that of the PPECD group [(94.7±6.3) min, P < 0.001]. Compared with those before surgery, the VAS scores and NDI index of the two groups of patients at each postoperative time were significantly improved (P < 0.05). According to the Macnab standard, the clinical effective rate of patients treated with PPECD (82.9%, 29/35) was higher than that of PCN (75.0%, 24/32), but the difference was not statistically significant (P > 0.05). No serious postoperative complications were observed in either group of patients. Conclusion For patients with poor tolerance to surgery, PCN can be a good alternative to PPECD for patients with cervical spondylotic radiculopathy due to a single-level contained soft-disc herniation.
- Cervical spondylotic radiculopathy /
- Cervical disc herniation /
- Posterior percutaneous endoscopic cervical discectomy /
- Percutaneous cervical nucleoplasty

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表 1 2组神经根型颈椎病患者一般资料比较

Table 1. Comparison of general characteristics between two groups of patients with cervical spondylotic radiculopathy

组别	例数	性别(女性/男性, 例)	年龄(x±s, 岁)	病程(x±s, 月)	突出节段(C_4~5/C_5~6/C_6~7, 例)	手术时间(x±s, min)
PPECD	35	15/20	53.1±9.4	11.1±4.0	7/15/13	94.7±6.3
PCN	32	23/9	54.5±7.4	11.3±3.8	13/12/7	42.0±6.4
统计量		5.734^a	0.691^b	0.204^b	3.807^a	33.860^b
P值		0.017	0.492	0.839	0.149	＜0.001
注：^a为χ²值，^b为t值。

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表 2 2组神经根型颈椎病患者手术前后VAS评分比较(x±s, 分)

Table 2. Comparison of VAS scores between two groups of patients(x±s, points)

组别	例数	术前	术后1 d	术后7 d	术后1个月	术后3个月	术后6个月	术后12个月
PPECD	35	6.0±0.9	3.6±0.6^a	3.3±0.5^a	2.1±0.6^a	1.7±0.7^a	1.1±0.7^a	0.9±0.6^a
PCN	32	6.0±0.8	3.7±0.6^a	3.3±0.7^a	2.2±0.5^a	1.9±0.6^a	1.6±0.7^a	1.3±0.9^a
F值		0.147	0.598	0.245	0.536	0.989	3.030	2.086
P值		0.883	0.552	0.807	0.594	0.326	0.003	0.041
注：与同组术前比较, ^aP＜0.05。

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表 3 2组神经根型颈椎病患者手术前后NDI指数比较(x±s)

Table 3. Comparison of NDI index between two groups of patients

组别	例数	术前	术后1 d	术后7 d	术后1个月	术后3个月	术后6个月	术后12个月
PPECD	35	33.3±1.3	28.2±1.5^a	25.4±1.4^a	14.8±1.3^a	11.7±1.3^a	8.2±1.3^a	7.3±1.4^a
PCN	32	33.2±1.1	27.6±1.7^a	25.0±1.4^a	14.9±1.3^a	11.8±1.3^a	8.2±1.2^a	6.8±1.0^a
F值		0.341	1.625	1.073	0.340	0.031	0.032	1.555
P值		0.734	0.109	0.287	0.735	0.975	0.974	0.125
注：与同组术前比较, ^aP＜0.05。

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表 4 2组神经根型颈椎病患者术后12个月治疗优良率比较

Table 4. Comparison of clinical efficacy between two groups of patients after 12 months

组别	例数	优(例)	良(例)	可(例)	差(例)	优良率(%)
PPECD	35	19	10	4	2	82.9
PCN	32	15	9	6	2	75.0
注：2组优良率比较，χ²=0.624，P=0.429。

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