目的 探讨经后路颈椎全内镜下椎间盘切除术（posterior percutaneous endoscopic cervical discectomy, PPECD）治疗单节段不完全性无骨折脱位型颈脊髓损伤（spinal cord injury without radiographic abnormality, SCIWORA）的临床疗效及术后并发症。方法 选取2017年1月—2019年12月就诊的51例SCIWORA患者进行前瞻性研究,按随机数字表法分为对照组与观察组,观察组21例,对照组30例。对照组接受前路减压椎间植骨融合内固定术（anterior cervical discectomy fusion, ACDF）,观察组接受PPECD。记录手术时间、术中出血量、术中透视次数。术后随访3个月,通过对比术前、术后3 d、术后3个月颈部、上肢VAS评分、颈部JOA评分、颈椎Cobb角、颈椎活动度（range of motion, ROM）,评价临床疗效;记录对比术后并发症发生率。结果 观察组术中出血量及术后透视时间较对照组对比具有统计学差异（P<0.05）;术后3 d、术后3个月VAS评分和JOA评分均较术前好转（P<0.05）,两组间无统计学差异（P>0.05）;术后3个月颈椎Cobb角及颈椎ROM较术前均好转（P<0.05）,且观察组对比对照组具有统计学差异（P<0.05）。观察组较对照组改变更佳;两组均未发生硬膜外血肿及神经硬膜损伤并发症发生;对照组中术后3个月内见1例切口感染（3.33%）,3例切口水肿并发症发生（10.00%）。结论 PPECD与ACDF治疗SCIWORA患者术后短期疗效相当,PPECD术中出血量更少,但术中透视次数较多;术后均可改善颈椎Cobb角和活动度,但PEECD较ACDF改善更佳,且术后并发症更少。
Objective To investigate the clinical efficacy of percutaneous posterior endoscopic cervical discectomy （PPECD） on incomplete single-segment spinal cord injury without radiographic abnormality （SCIWORA） and its complications. Methods A total of 51 patients with SCIWORA from January 2017 through December 2019 were divided into a control group and an observation group according to the random number table method. The observation group （n=21） received PPECD, and the control group （n=30） received anterior cervical discectomy fusion （ACDF）. Follow up lasted 3 months. Operation time, intraoperative blood loss volume, and fluoroscopy times were recorded. The VAS scores of neck and upper limbs, JOA scores of neck, cervical Cobb angle, and range of motion （ROM） in the two groups before and 3 months after operation were recorded and compared. The incidence rate of postoperative complications was also recorded and compared. Results There were significant differences between the two groups in intraoperative blood loss volume and fluoroscopy times （P<0.05）. At 3 days and 3 months after operation, the VAS scores and JOA scores were improved compared with the scores before operation （P<0.05）, but there was no significant difference between the two groups （P>0.05）. The cervical Cobb angle and ROM of the two groups were improved 3 months after operation （P<0.05）, and observation group had greater improvement than the control group （P<0.05）. No epidural hematoma or neurodural injury occurred in the two groups. In control group, 1 case of incision infection （3.33%） and 3 cases of incision edema （10.00%） occurred within 3 months after operation. Conclusion The short-term clinical efficacies of PPECD and ACDF on SCIWORA are similar. PPECD features less intraoperative blood loss but more times of fluoroscopy. Although both surgeries can improve cervical Cobb angle and ROM, but PPECD has greater effects and produces less postoperative complications than ACDF.
[1] Azwedowski D, Walecki J.Spinal cord injury without radiographic abnormality (SCIWORA)-clinical and radiological aspects[J]. Pol J Radiol, 2014, 79:461-464.
[2] Qi C, Xia H, Miao D, et al.The influence of timing of surgery in the outcome of spinal cord injury without radiographic abnormality (SCIWORA)[J]. J Orthop Surg Res, 2020, 15(1):100-108.
[3] Nagoshi N, Tetreault L, Nakashima H, et al.Return to play in athletes with spinal cord concussion: a systematic literature review[J]. Spine J, 2017, 17(2):291-302.
[4] 吴成如,汪念,孙军战,等.无骨折脱位型颈脊髓损伤的分类与手术治疗研究[J].颈腰痛杂志, 2020,41(1):15-19.
[5] 李洪. 影响无骨折脱位型颈脊髓损伤手术疗效的多因素分析[J].中国骨伤,2020, 33(2):158-165.
[6] Elliott IS, Spiker WR, Caputo AM, et al.Anterior cervical decompression and fusion versus cervical disk arthroplasty[J]. J Spinal Disord Tech, 2015, 28(9):309-312.
[7] Wu PF, Li YW, Wang B, et al.Posterior cervical foraminotomy via full-endoscopic versus microendoscopic approach for radiculopathy: a systematic review and meta-analysis[J]. Pain Physician, 2019,22(1):41-52.
[8] Ruetten S, Komp M, Merk H, et al.Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9 mm endoscopes: a prospective, randomized, controlled study[J]. Spine (Phila Pa 1976), 2008, 33(9):940-948.
[9] Ahn Y.Percutaneous endoscopic cervical discectomy using working channel endoscopes[J]. Expert Rev Med Devices, 2016, 13(6):601-610.
[10] 章薇,章翔,贺亚龙,等.急性成人无骨折脱位型颈髓损伤手术冶疗研究[J].中华神经外科疾病研究杂志, 2017,16(6): 498-501.
[11] Mohanty SP, Bhat NS, Singh KA, et al.Cervical spinal cord injuries without radiographic evidence of trauma: a prospective study[J]. Spinal Cord, 2013, 51(11):815-820.
[12] 李宁,周悦,刘猛,等.颈前路椎间盘切除减压融合术中应用零切迹自稳型融合器和融合器并钛板内固定的临床疗效比较[J].徐州医科大学学报,2021,41(1):45-50.
[13] Tan M, Rooden CJ, Westerbeek RE, et al.Diagnostic management of clinically suspected acute deep vein thrombosis[J]. Br J Haematol, 2009,146(4):347-360.
[14] 福嘉欣,江毅.颈椎后路单开门椎管扩大成形术后相关并发症的研究进展[J]. 脊柱外科杂志, 2016,14(1):58-61.
[15] 游景扬,郑勇,陈明.颈椎前路与后路手术治疗多节段脊髓型颈椎病疗效的Meta分析[J].中国骨伤, 2017, 30(1):71-78.
[16] Adamson TE.Microendoscopic posterior cervical lamino-foraminotomy for unilateral radiculopathy: results of a new technique in 100 cases[J]. J Neurosurg, 2001,95(1):51-57.
[17] 楚磊,陈亮,汪洋,等.后路经皮内窥镜下颈椎间盘髓核摘除术治疗颈椎间盘突出症[J].重庆医科大学学报,2014,39(2):219-222.
[18] 刘国萍,曹奇,唐晓军,等.内镜下椎间孔成形治疗颈椎椎间孔狭窄症[J].中国矫形外科杂志, 2020, 493(11):29-33.
[19] 杨学军,梁鹏展,陈晓东,等.颈椎后路经皮内镜椎间盘切除术对单节段神经根型颈椎病患者NDI指数与ROM的影响[J].中国医学创新, 2020,17(27):32-36.
[20] Yong A.Percutaneous endoscopic cervical discectomy using working channel endoscopes[J]. Expert Rev Med Dev, 2016,13(6):601-610.
[21] Kong W, Xin Z, Du Q, et al.Anterior percutaneous full endoscopic transcorporeal decompression of the spinal cord for single segment cervical spondylotic myelopathy: the technical interpretation and 2 years of clinical follow up[J]. J Orthop Surg Res, 2019, 14(1):461-465.
[22] Su N, Fei Q, Wang B Q, et al.Comparison of clinical outcomes of expansive open-door laminoplasty with unilateral or bilateral fixation and fusion for treating cervical spondylotic myelopathy: a multi-center prospective study[J]. BMC Surg,2019,19(1):116-117.
[23] 秦光华,赵寅,姚剑南.改良式与传统内镜下颈椎管成形术治疗脊髓型颈椎病的对比研究[J].颈腰痛杂志, 2020, 41(1):55-57.
