内镜下锁孔技术治疗单节段神经根型颈椎病△

Large channel endoscopic keyhole technique for singlelevel cervical spondylotic radiculopathy

摘要:

[目的] 比较大通道脊柱内镜下锁孔技术 （large channel endoscopic keyhole technique, LCEKT） 与颈椎前路椎间盘切除融合术 （anterior cervical discectomy and fusion, ACDF） 治疗单节段神经根型颈椎病 （cervical spondylotic radiculopathy, CSR） 的临床疗效。[方法] 回顾性分析 2020 年 12 月—2023 年 9 月本院手术治疗的 46 例手术治疗 CSR 的患者。根据医患沟通结果，21 例行 LCEKT，25 例行 ACDF。比较两组围手术期、随访和影像学结果。[结果] 两组患者均顺利完成手术。LCEKT 组患者手术时间 [(78.4±10.1) min vs (93.4±9.6) min, P＜0.001]、术中出血量 [(13.2±5.2) mL vs (52.4±7.6) mL, P＜0.001]、切口长度 [(0.8± 0.1) cm vs (5.1±0.2) cm, P＜0.001]、术中透视次数 [(4.2±0.5) 次 vs (6.7±1.2) 次, P＜0.001]、下地行走时间 [(15.7±6.5) d vs (34.6±3.7) d, P＜0.001] 和住院时间 [(5.6±1.0) d vs (9.3±1.3) d, P＜0.001] 均显著少于 ACDF 组。随访时间平均 （13.6±0.8） 个月。随术后时间推移，两组患者的颈部 VAS、上肢 VAS、NDI、JOA 评分均显著改善 （P＜0.05），除术后 1 周时 LCEKT 组颈部 VAS 评分 [(2.3± 0.6) vs (3.5±0.7), P＜0.001] 显著优于 ACDF 组外，相同时间点，两组上述指标的差异均无统计学意义 （P＞0.05）。影像方面，与术前相比，两组患者术后颈椎前凸角、椎管占位率均显著改善（P＜0.05）；两组颈椎活动度及 LCEKT 组椎间隙高度均无显著变化 （P＞0.05），ACDF 组椎间隙高度显著增加 （P＜0.05）。术前两组上述指标的差异均无统计学意义 （P＞0.05），末次随访时， LCEKT 组颈椎前凸角 [(12.6±2.3)° vs (15.7±2.5)°, P＜0.001]、椎间隙高度 [(5.4±0.5) mm vs (7.5±0.7) mm, P＜0.001] 显著小于 ACDF 组 ，但 LCEKT 组颈椎活动度显著大于 ACDF 组 [(44.0±5.7)° vs (38.4±5.6)°, P=0.002]。[结论] 两种手术方法在治疗 CSR 上均可取得良好的临床效果，但 LCEKT 治疗 CSR 具有创伤小、出血少、恢复快以及保留颈椎的节段活动度等优点，另外大通道脊柱内镜系统为术者提供了更广阔的镜下视野和更灵活的操作空间，从而提高了手术效率并降低了手术风险。

Abstract:

[Objective] To compare the clinical consequence of large channel endoscopic keyhole technique, (LCEKT) versus anterior cervical discectomy and fusion (ACDF) for single-level cervical spondylotic radiculopathy (CSR). [Methods] A retrospective study was performed on 46 patients who underwent surgical treatment for CSR in our hospital from December 2020 to September 2023. According to preoperative doctor-patient communication, 21 patients received LCEKT, while other 25 patients underwent ACDF. The documents regarding perioperative period, follow-up and images were compared between the two groups. [Results] The operation was successfully completed in both groups. The LCEKT group was proved significantly superior to the ACDF group in terms of operative time [(78.4±10.1) min vs (93.4± 9.6) min, P＜0.001], intraoperative blood loss [(13.2±5.2) mL vs (52.4±7.6) mL, P＜0.001], incision length [(0.8±0.1) cm vs (5.1±0.2) cm, P＜ 0.001], intraoperative fluoroscopy times [(4.2±0.5) vs (6.7±1.2), P＜0.001] ambulation time [(15.7±6.5) days vs (34.6±3.7) days, P＜0.001] and hospital stay [(5.6±1.0) days vs (9.3±1.3) days, P＜0.001]. With time of the follow-up period lasted for (13.6±0.8) months in a mean, the neck pain VAS, upper limb pain VAS, NDI and JOA scores were significantly improved in both groups (P＜0.05). Except that the neck VAS score in the LCEKT group [(2.3±0.6) vs (3.5±0.7), P＜0.001] was significantly better than that in the ACDF group 1 week after surgery, there was no statistical significance in the abovesaid indexes between the two groups at any time points accordingly (P＞0.05). Regarding imaging, the postoperative cervical lordosis angle and vertebral canal occupancy rate were significantly improved in both groups compared with those preoperative (P＜0.05). The cervical range of motion (ROM) and intervertebral height remained unchanged in the LCEKT group (P＞0.05), whereas the intervertebral height in ACDF group was significantly increased postoperatively compared with that preoperatively (P＜0.05). Although there was no statistical significance in the above imaging parameters between the two groups before surgery (P＞0.05), the LCEKT group had significantly less cervical lordosis angle [(12.6±2.3)° vs (15.7±2.5)°, P＜0.001] and intervertebral height [(5.4±0.5) mm vs (7.5± 0.7) mm, P＜0.001], whereas significantly greater cervical ROM [(44.0±5.7)° vs (38.4±5.6)°, P=0.002] than the ACDF group at the latest follow-up. [Conclusion] Both surgical techniques do achieve good clinical results in the treatment of CSR. By comparison, the LCEKT has the advantages of less trauma, less bleeding, faster recovery, and preserving cervical segmental motion over the ACDF. In addition, the large-channel endoscopic system provides the surgeon with a broader view field and more flexible operating space to improve operative efficiency and reduce surgical risk.