[1]李春根*,江泽辉,李鹏洋,等.低温等离子髓核消融术治疗神经根型颈椎病的中期临床疗效观察[J].中国微创外科杂志,2017,17(5):402-406.
　Li Chungen,Jiang Zehui,Li Pengyang,et al.Mid-term Outcomes of Percutaneous Cervical Disc Nucleoplasty for the Treatment of Cervical Spondylotic Radiculopathy[J].Chinese Journal of Minimally Invasive Surgery,2017,17(5):402-406.
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低温等离子髓核消融术治疗神经根型颈椎病的中期临床疗效观察()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年5期
页码:
402-406
栏目:
临床论著
出版日期:
2017-07-14

文章信息/Info

Title:
Mid-term Outcomes of Percutaneous Cervical Disc Nucleoplasty for the Treatment of Cervical Spondylotic Radiculopathy
作者:
李春根*; 江泽辉; 李鹏洋; 康晓乐; 叶超; 元小红; 伍绍明; 于海川
北京东直门医院骨二科，北京100700
Author(s):
Li Chungen;  Jiang Zehui;  Li Pengyang;  et al.
Department of Orthopaedics, Beijing Dongzhimen Hospital, Beijing 100700, China
关键词:
低温等离子髓核消融术; 神经根型颈椎病; 中期临床疗效
Keywords:
Percutaneous cervical disc nucleoplasty; Cervical spondylotic radiculopathy; Mid-term outcomes
文献标志码:
A
摘要:
目的观察低温等离子髓核消融术(percutaneous cervical disc nucleoplasty，PCDN)治疗神经根型颈椎病(cervical spondylotic radiculopathy，CSR)的中期临床疗效。方法2010年4月～2013年6月我科采用PCDN在局麻和影像学监视下靶向穿刺，消融及热凝（射频能量100 Hz）治疗CSR 231例，其中135例获得2年以上随访，采用日本整形外科田中靖久(Yasuhisa Tanaka)的症状量化表20分法（简称YT 20分法）、改良MacNab评分法对术后1、3、6、12、24个月和末次随访的疗效进行评价。结果均为单节段手术，其中C4~5 32例，C5~6 64例，C6~7 39例。术后未发生神经根损伤、大血管破裂、穿刺点感染及椎间隙感染等并发症。135例门诊随访2～5年1个月，中位数3.2年。术后1、3、6、12、24个月YT 20评分分别为（1435±4.47），（14.82±4.94），（15.71±5.43），（15.77±5.56），（15.29±5.64）分，均较术前（8.87±4.29）分明显提高（P均=0.000）；术后1、3、6、12、24个月YT 20分法优良率分别为47.4%（64/135）、57.0%（77/135）、65.9%（89/135）、65.2%（88/135）、615%（83/135），有效率分别为77.0%（104/135）、78.5%（106/135）、77.0%（104/135）、74.8%（101/135）、71.9%（97/135），术后3、6、12、24个月YT 20分法疗效均明显优于术后1个月(P＜0.05)。术后复发27例，占20.0%（27/135）。术后1、3、6、12、24个月改良MacNab疗效评价，优良率分别为64.4%（87/135）、65.2%（88/135）、70.4%（95/135）、67.4%（91/135）、644%（87/135），有效率分别为85.2%（115/135）、85.2%（115/135）、83.0%（112/135）、80.7%（109/135）和785%（106/135）；术后3、6、12个月改良MacNab疗效均明显优于术后1个月(P＜0.05)，术后6、12个月分别优于术后3、24个月(P＜0.05)。结论PCDN能明显改善CSR患者颈肩背部及上肢酸胀、疼痛、麻木等症状，提高患者的日常生活与工作能力，中期疗效满意。
Abstract:
ObjectiveTo observe the mid-term outcomes of percutaneous cervical disc nucleoplasty (PCDN) for cervical spondylotic radiculopathy（CSR）.MethodsA total of 231 patients with CSR were treated by PCDN (power, 100 Hz) under local anesthesia and image guidance in our hospital from April 2010 to June 2013. The Japanese Orthopedic Associations of Yasuhisa Tanaka 20 (YT 20) score and the modified MacNab score were used to evaluate the results at 1, 3, 6, 12, 24 months after surgery and final follow-up after operation, respectively.ResultsThe single segment surgery was performed in all the cases, including C4-5 in 32 cases, C5-6 in 64 cases, and C6-7 in 39 cases. No neurovascular injury or infection was noted. A total of 135 cases were followed up completely in the outpatient for 2 months to 5 years and 1 month (median, 3.2 years). At postoperation of 1, 3, 6, 12, and 24 months, the YT 20 scores were (14.35±4.47), (14.82±4.94), (15.71±5.43), (15.77±5.56), and (15.29±5.64)points, respectively, which were significantly higher than preoperative counterparts (P=0.000). The excellent and good rates were 47.4% (64/135), 57.0% (77/135), 65.9% (89/135), 65.2% (88/135) and 61.5% (83/135), respectively. The effective rates were 77.0% (104/135), 78.5% (106/135), 77.0% (104/135), 74.8% (101/135), and 71.9% (97/135), respectively. At postoperation of 3, 6, 12, and 24 months, the YT 20 scores were significantly higher than postoperation 1 month counterparts (P<005). Postoperative recurrence was found in 27 cases, accounting for 20.0%(27/135). According to the modified MacNab criteria, the excellent and good rates at 1,3,6,12, 24 months, and final follow-up after operation were 64.4% (87/135), 65.2% (88/135), 70.4% (95/135), 67.4% (91/135), and 64.4% (87/135),and the effective rates were 85.2% (115/135),85.2% (115/135), 83.0% (112/135), 80.7% (109/135) and 78.5% (106/135), respectively. At postoperation of 3, 6, and 12 months, the modified MacNab scores were significantly higher than postoperation of 1 month counterparts(P<0.05), and at postoperation of 6 and 12 months, the scores were significantly higher than postoperation of 3 and 24 months counterparts (P<0.05). ConclusionPCDN can obviously relieve the symptoms of patients with CSR, such as pain, numbness of neck, shoulder and upper limb, as well as improve the patient’s quality of daily life, which shows good mid-term outcomes.

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备注/Memo

备注/Memo:
*通讯作者，E-mail:leechungen@126.com
更新日期/Last Update: 2017-07-14