两种后路术式治疗单侧神经根型颈椎病的比较（开放获取）

Comparison of two posterior procedures for unilateral cervical spondylotic radiculopathy

摘要:

[目的] 比较单侧双通道脊柱内镜技术(unilateral biportal endoscopy, UBE)与单开门椎管扩大成形术(posterior cervical single-door laminoplasty, PCSDL)治疗单侧神经根型颈椎病(cervical spondylotic radiculopathy, CSR)的临床疗效。[方法] 回顾性分析2021年10月—2024年9月滨州医学院附属医院脊柱外科及郓城县人民医院骨科收治的86例CSR患者的临床资料,根据医患沟通结果,43例采用UBE,另外43例采用PCSDL。比较两组围手术期、随访及影像资料。[结果] UBE组手术时间[min, (116.3±22.2) vs (189.8±27.7), P<0.001]、术中出血量[mL, (58.8±9.3) vs (155.2±10.4), P<0.001]、切口总长度[cm, (2.7±0.7) vs (9.3±1.1), P<0.001]、下地行走时间[d, (2.0±0.4) vs (2.4±0.5), P<0.001]、住院时间[d, (6.9±1.5) vs (11.5±3.8), P<0.001]均显著优于PCSDL组,但前者术中透视次数显著多于后者[次, (5.0±0.6) vs (1.4±0.5), P<0.001]。患者均获12个月以上随访,两组术后恢复完全负重活动时间的差异无统计学意义(P>0.05),与术前相比,术后3个月及末次随访时,两组颈项痛及上肢痛VAS评分、NDI指数和JOA评分均显著改善(P<0.05)。相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。影像方面,末次随访时UBE组椎管面积[mm2, (104.7±10.8) vs (117.2±14.5), P<0.001]明显不及PCSDL组,两组椎间孔面积、颈椎前凸角的差异均无统计学意义(P>0.05)。[结论] UBE与单开门椎管减压成形术治疗CSR均具有较高的安全性和可靠性,UBE技术更具微创优势,具有手术切口短、术中出血量少、手术时间短、术后恢复快等优势。

Abstract:

[Objective] To compare the clinical efficacy of unilateral biportal endoscopy (UBE) versus posterior cervical single-door laminoplasty (PCSDL) in the treatment of unilateral cervical spondylotic radiculopathy (CSR). [Methods] A retrospective study was done on 86 patients who had CSR treated surgically in Department of Spine Surgery, Affiliated Hospital, Binzhou Medical University and the Department of Orthopedics, People's Hospital of Yuncheng County from October 2021 to September 2024. According to the communication between doctors and patients, 43 patients were treated with UBE, while the other 43 patients were treated with PCSDL. The perioperative, follow-up, and imaging data of the two groups were compared. [Results] The UBE group proved significantly superior to the PCSDL group in terms of operation time [min, (116.3±22.2) vs (189.8±27.7), P<0.001], intraoperative blood loss [mL, (58.8±9.31) vs (155.2±10.4), P<0.001], total incision length [cm, (2.7±0.7) vs (9.3±1.1), P<0.001], time to get off bed [d, (2.0±0.4) vs (2.4 0.5), P<0.001], and hospital stay [d, (6.9±1.5) vs (11.5±3.8), P<0.001], but the former consumed significantly more intraoperative fluoroscopy than the latter [times, (5.0±0.6) vs (1.4±0.5), P<0.001]. All patients in both groups were followed up for more than 12 months, and there was no a statistically significant difference in the time to resume full weight-bearing activity after surgery between the two groups (P>0.05). Compared with those preoperatively, the VAS scores of neck pain and upper limb pain, NDI and JOA score in both groups significantly improved at 3 months after operation and the last follow-up (P<0.05). At any corresponding time points, there were no statistically significant differences in the above indicators between the two groups (P>0.05). Regarding to imaging, the UBE group had a significantly less area of the spinal canal than the PCSDL group [mm2, (104.7±10.8) vs (117.2±14.5), P<0.001], whereas no significant differences were found in intervertebral foramen area and cervical lordosis between the two groups at the last follow-up (P>0.05). [Conclusion] Both UBE and PCSDL have high safety and reliability in the treatment of CSR. The UBE has advantage of minimally invasive surgery, such as shorter surgical incision, less intraoperative blood loss, shorter operation time, and faster postoperative recovery over the PCSDL.