后路经皮内窥镜下颈椎间盘髓核摘除术治疗颈椎间盘突出症

Posterior percutaneous full endoscopic cervical discectomy for cervical intervertebral disc herniation

摘要:

目的：探讨后路经皮内窥镜下颈椎间盘髓核摘除术治疗颈椎间盘突出症的安全性、可行性及短期疗效。方法：2011年8月至2012年10月，共对23例患者实施后路经皮内窥镜下颈椎间盘髓核摘除术。男性9例，女性14例。C4/5节段3例、C5/6节段15例、C6/7节段6例。单节段22例，双节段1例。相应症状均表现为神经根卡压节段性根性疼痛。全麻下患者取俯卧位，在直径6.3 mm经皮内窥镜直视下，采用磨钻去除相应节段上下关节突内侧部分及部分椎板，呈“钥匙孔”样显露，去除突出的椎间盘髓核组织，减压神经根。记录术前及术后1 d、1周、1月、3月、6月、1年患者视觉模拟评分（visual analog scale，VAS）及末次随访Macnab评分。结果：手术均顺利完成，全部病例得到随访。术前及术后各时间点VAS分别为（7.35±1.05）、（2.87±0.84）、（1.85±0.42）、（1.72±0.64）、（1.40±0.75）、（0.75±1.58）、（0.77±1.08）分。术后各时间点VAS较术前明显减少，差异具有统计学意义（P<0.05）。改良Macnab标准评价临床疗效，优15例，良7例，可1例。结论：后路经皮内窥镜下颈椎间盘髓核摘除术治疗颈椎间盘突出症疗效满意，安全可行，值得推广应用。

Abstract:

Objective：To evaluate the safety，feasibility and short-term efficacy of posterior percutaneous endoscopic cervical discectomy in the treatment of cervical intervertebral disc herniation． Methods：From August 2011 to October 2012，23 patients were treated with posterior percutaneous endoscopic cervical discectomy，3 cases at C4/5 level，15 cases at C5/6 level，6 cases at C6/7 level，22 cases of single level and one case of double levels. Corresponding symptom was segmental radicular pain cased by nerve root compression. All patients were in the prone position under general anesthesia. With percutaneous endoscope（diameter of 6.3 mm），a small amount of the inner part of the upper and lower facet and part of the lamina at the corresponding segments were removed by burr. The working path was shown as ‘key hole’ sample，then the herniated disc nucleus pulposus was got rid of and nerve root was released. The visual analog scale（VAS） scores of peroperation，1 d，1week，1 month，3 months，6 months，1 year postoperatively and modified MacNab criteria at the last follow-up were recorded. Results：All operations were successful in 23 cases and all patients were followed up. VAS scores at each time point were 7.35±1.05，2.87±0.84，1.85±0.42，1.72±0.64，1.40±0.75，0.75±1.58，0.77±1.08，respectively. VAS scores at each time point were significantly reduced after the operationthan than before the peroperation，with statistical significances（P<0.05）. Modified MacNab showed there were 15 excellent cases，7 good cases and 1 fine case. Conclusions：Posterior percutaneous endoscopic cervical discectomy is safe and effective in the treatment of cervical intervertebral disc herniation and should be widely applied.