环锯在前路内镜颈椎经椎体减压的应用

Trephine used in anterior endoscopic cervical transcorporeal discectomy

摘要:

[目的] 探讨环锯在前路内镜颈椎经椎体减压术 （anterior endoscopic cervical transcorporeal decompression, AECTcD） 中的应用效果。[方法] 回顾性分析 2018 年 9 月—2019 年 9 月采用外径 6.6 mm 环锯钻孔行 AECTcD 治疗颈椎间盘突出症 29 例患者。观察临床及影像效果。[结果]所有患者手术均顺利完成，术中无食管、血管、神经损伤等严重并发症。手术时间平均 （86.0±9.3）min，切口均 I 期愈合，住院时间平均（5.6±1.8）d。所有患者随访时间平均（29.2±3.7）个月，与术前相比，术后 24 个月 VAS 评分显著减少（P＜0.05），JOA 评分显著增加（P＜0.05）。影像方面，与术前相比，术后 24 个月椎间盘高度较术前显著降低（P＜0.05），椎管面积较术前显著增加（P＜0.05），钻孔椎体高度较术前差异无统计学意义（P＞0.05），末次随访骨通道已骨性愈合。[结论]AECTcD 中环锯的应用加强了椎体骨通道建立的可控性，提高了骨通道建立的精准性。

Abstract:

[Objective] To explore the clinical outcomes of trephine used in anterior endoscopic cervical transcorporeal discectomy (AECTcD) for cervical disc herniation. [Methods] From Sep. 2018 to Sep. 2019, 29 patients received AECTcD with trephine used for creat- ing a bone tunnel for central cervical disc herniation (CDH) in our departments. The clinical and imaging consequences were evaluated. [Re- sults] All the patients had operation performed smoothly without injuries to blood vessel, nerves and esophagus, whereas with operation time of (86.0±9.3) min on an average, well incision healing and hospital stay of (5.6±1.8) days. The VAS score significantly decreased, while JOA score significantly increased at the latest follow-up lasted for (29.2±3.7) months on an average compared with those preoperatively (P＜0.05). Radiographically, the intervertebral disc height decreased significantly (P＜0.05), whereas the cross-section area of spinal canal increased significantly (P＜0.05), and the involved vertebral body height remained unchanged (P＜0.05) at the latest follow up compared with those pre- operatively. [Conclusion] The trephine used in AECTcD takes the advantages of higher controllability and accuracy for the establishment of bony channel.