颈椎前路手术减压程度对神经根型颈椎病的影响
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摘要
目的探讨颈椎前路手术的减压程度对神经根型颈椎病的影响。方法 84例神经根型颈椎病患者2016年1月～2018年1月于首都医科大学附属北京潞河医院完成颈椎前路减压融合手术。根据术后随访时患者对手术疗效的主观缓解程度分为完全缓解组(73例)和未完全缓解组(11例)。分别记录测量每位患者术前及术后随访时手术节段MRI轴位像上致压物的面积、视觉模拟评分(VAS)和颈椎功能障碍指数(NDI)评分。记录每位患者术中出血量及手术时间,观察围术期及近中期并发症。结果所有患者均顺利完成手术,平均手术时间为(131.45±9.45)min,平均术中出血量为(51.23±31.16)mL。两组术后VAS及NDI评分均较术前降低,致压物面积较术前减小,差异有统计学意义(P <0.05)。完全缓解组术后VAS及NDI评分均较未完全缓解组降低,致压物面积较未完全缓解组减小,差异有统计学意义(P <0.05)。所有患者中无椎动脉损伤,围术期无术后血肿形成。结论颈椎前路手术是治疗神经根型颈椎病的有效手段,但部分患者术后症状的残留可能与术中减压不彻底有关,彻底减压不会明显增加术后并发症。
Objective To investigate the effect of decompression extent of cervical anterior approach on cervical spondylotic radiculopathy(CSR). Methods From January 2016 to January 2018, 84 CSR patients were performed with anterior cervical discectomy and fusion(ACDF) in Beijing Luhe Hospital, Capital Medical University. According to degree of remission at the postoperative follow-up, the patients were divided into two groups(complete remission group,73 cases and incomplete remission group, 11 cases). Compressive areas in operative level, visual analogue scale(VAS)and neck disability index(NDI) of patients were recorded at pre-operation and postoperative follow-up. Intra-operative blood loss and duration of operation were recorded. The post-operation and on short and midium term complications were also concerned. Results All of the patients were performed with operation successfully, average of duration of operation was(131.45±9.45) min and average of intra-operative blood loss was(51.23±31.16) m L. Postoperative VAS and NDI scores in both groups were lower than those before operation, and the area of pressure substance in both groups was smaller than that before operation, there was significant difference between two groups(P < 0.05). Postoperative VAS and NDI scores of complete remission group were lower than those of incomplete remission group, and the area of pressure substance of complete remission group was smaller than that of incomplete remission group, there was significant difference between two groups(P < 0.05). There was no vertebral artery injury or hematoma formation during perioperative period in all patients. Conclusion ACDF is a valid method for the therapy of CSR, but residual symptom of partial patients may be related with incomplete decompression. Complete decompression would not markedly increase the complications.
Objective To investigate the effect of decompression extent of cervical anterior approach on cervical spondylotic radiculopathy(CSR). Methods From January 2016 to January 2018, 84 CSR patients were performed with anterior cervical discectomy and fusion(ACDF) in Beijing Luhe Hospital, Capital Medical University. According to degree of remission at the postoperative follow-up, the patients were divided into two groups(complete remission group,73 cases and incomplete remission group, 11 cases). Compressive areas in operative level, visual analogue scale(VAS)and neck disability index(NDI) of patients were recorded at pre-operation and postoperative follow-up. Intra-operative blood loss and duration of operation were recorded. The post-operation and on short and midium term complications were also concerned. Results All of the patients were performed with operation successfully, average of duration of operation was(131.45±9.45) min and average of intra-operative blood loss was(51.23±31.16) m L. Postoperative VAS and NDI scores in both groups were lower than those before operation, and the area of pressure substance in both groups was smaller than that before operation, there was significant difference between two groups(P < 0.05). Postoperative VAS and NDI scores of complete remission group were lower than those of incomplete remission group, and the area of pressure substance of complete remission group was smaller than that of incomplete remission group, there was significant difference between two groups(P < 0.05). There was no vertebral artery injury or hematoma formation during perioperative period in all patients. Conclusion ACDF is a valid method for the therapy of CSR, but residual symptom of partial patients may be related with incomplete decompression. Complete decompression would not markedly increase the complications.
引文
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[15] Schelfaut S,Verhasselt S,Carpentier K,et al. Subaxial rotational vertebral artery syndrome:resection of the uncinate process and anterior fusion can be sufficient:case report and review of the literature[J]. J Spinal Disord Tech,2015,28(2):66-70.
[16] Kim HJ,Nemani VM,Piyaskulkaew C,et al. Cervical radiculopathy:incidence and treatment of 1,420 consecutive cases[J]. Asian Spine J,2016,10(2):231-237.
[17] Geck MJ,Eismont FJ. Surgical options for the treatment of cervical spondylotic myelopathy[J]. Orthop Clin North Am,2002,33(2):329-348.
[18] Rao RD,Currier BL,Albert TJ,et al. Degenerative cervical spondylosis:clinical syndromes,pathogenesis,and management[J]. J Bone Joint Surg Am,2007,89(6):1360-1378.
[19] Siemionow KB,Neckrysh S. Anterior approach for complex cervical spondylotic myelopathy[J]. Orthop Clin North Am,2012,43(1):41-52.
[20] Ebraheim NA,An HS,Xu R,et al. The quantitative anatomy of the cervical nerve root grove and the intervertebral foramen[J]. Spine,1996,21(14):1619-1623.
[21] Tanaka N,Fujimoto Y,An HS,et al. The anatomic relation among the nerve roots,intervertebral foramina,and intervertebral discs of the cervical spine[J]. Spine,2000,25(3):286-291.
[22]陈学明,冯世庆,许崧杰,等.神经根型颈椎病椎间孔内神经根受压的原因分析及减压方式选择[J].中国脊柱脊髓杂志,2015,25(2):103-108.
[2]赵定麟.颈椎伤病学[M].上海:上海科技教育出版社,1994:160.
[3] Sun Y,Muheremu A,Yan K,et al. Effect of different surgical methods on headache associated with cervical spondylotic myelopathy and/or radiculopathy[J]. BMC Surg,2015,15(1):105.
[4] Tasiou A,Giannis T,Brotis AG,et al. Anterior cervical spine surgery-associated complications in a retrospective casecontrol study[J]. J Spine Surg,2017,3(3):444-459.
[5] Huskisson EC. Measurement of pain[J]. Lancet,1974,2(7889):1127-1131.
[6] Vernon H,Mior S. The neck disability index:a study of reliability and validity[J]. J Manipulmive Physiol Ther,1991,14(7):409-415.
[7] Truumees E,Herkowitz HN. Cervical spondylotic myelopathy and radiculopathy[J]. Instr Course Lect,2000,49:339-360.
[8] Ando T. Diagnosis and management of cervical spondylosis[J]. Rinsho Shinkeigaku,2012,52(7):469-479.
[9] Boyce RH,Wang JC. Evaluation of neck pain,radiculopathy,and myelopathy:imaging,conservative treatment,and surgical indications[J]. Instr Course Lect,2003,52:489-495.
[10] Nikolaidis I,Fouyas IP,Sandercock PA,et al. Surgery for cervical radiculopathy or myelopathy[J]. Cochrane Database Syst Rev,2010,20(1):CD001466.
[11] Schroeder GD,Kurd MF,Millhouse PW,et al. Performing an anterior cervical discectomy and fusion[J]. Clin Spine Surg,2016,29(5):186-190.
[12] Liu WJ,Hu L,Chou PH,et al. Comparison of anterior cervical discectomy and fusion versus posterior cervical foraminotomy in the treatment of cervical radiculopathy:a systematic review[J]. Orthop Surg,2016,8(4):425-431.
[13] Wang T,Wang H,Liu S,et al. Incidence of C5 nerve root palsy after cervical surgery:a meta-analysis for last decade[J]. Medicine(Baltimore),2017,96(45):e8560.
[14] Obermuller T,Wostrack M,Shiban E,et al. Vertebral artery injury during foraminal decompression in"low-risk"cervical spine surgery:incidence and management[J]. Acta Neurochir(Wien),2015,157(11):1941-1945.
[15] Schelfaut S,Verhasselt S,Carpentier K,et al. Subaxial rotational vertebral artery syndrome:resection of the uncinate process and anterior fusion can be sufficient:case report and review of the literature[J]. J Spinal Disord Tech,2015,28(2):66-70.
[16] Kim HJ,Nemani VM,Piyaskulkaew C,et al. Cervical radiculopathy:incidence and treatment of 1,420 consecutive cases[J]. Asian Spine J,2016,10(2):231-237.
[17] Geck MJ,Eismont FJ. Surgical options for the treatment of cervical spondylotic myelopathy[J]. Orthop Clin North Am,2002,33(2):329-348.
[18] Rao RD,Currier BL,Albert TJ,et al. Degenerative cervical spondylosis:clinical syndromes,pathogenesis,and management[J]. J Bone Joint Surg Am,2007,89(6):1360-1378.
[19] Siemionow KB,Neckrysh S. Anterior approach for complex cervical spondylotic myelopathy[J]. Orthop Clin North Am,2012,43(1):41-52.
[20] Ebraheim NA,An HS,Xu R,et al. The quantitative anatomy of the cervical nerve root grove and the intervertebral foramen[J]. Spine,1996,21(14):1619-1623.
[21] Tanaka N,Fujimoto Y,An HS,et al. The anatomic relation among the nerve roots,intervertebral foramina,and intervertebral discs of the cervical spine[J]. Spine,2000,25(3):286-291.
[22]陈学明,冯世庆,许崧杰,等.神经根型颈椎病椎间孔内神经根受压的原因分析及减压方式选择[J].中国脊柱脊髓杂志,2015,25(2):103-108.