摘要
目的分析术前臂丛磁共振神经成像(MRN)定位突出颈椎间盘位置辅助经皮颈椎后路内镜颈椎间盘切除术(PPECD)精准减压的临床效果。方法选取39例行PPECD的神经根型颈椎病(CSR)患者,依据术前是否行臂丛MRN分为MRN组及常规组。纳入患者MRN组18例,对照组21例。比较两组手术时间,术中出血量,术中透视次数,术后患者上肢感觉、肌力较术前减退发生率,术中开骨窗左、右最长径及上、下最长径长度,患者术前、术后、术后6月、术后12月VAS评分、JOA评分、C2~C7 cobb角、手术节段椎间隙高度。结果MRN组手术时间、术中出血量、术中透视次数均优于常规组(P<0.001)。两组术后6月、12月患者JOA评分、VAS评分、C2~C7 Cobb角均较术前明显改善(P<0.05)。结论PPECD术前臂丛MRN精准定位突出的颈椎间盘位置可降低术中磨削开窗对关节突关节等结构的破坏,避免为寻找突出的颈椎间盘对颈神经及硬脊膜牵拉、推挤加重损伤,减少术中出血量、透视次数及手术时间,创伤更小,效果更好,安全性更高,患者康复更快。
Objective To analyze the clinical efficacy of precise decompression in posterior percutaneous endoscopic cervical discectomy(PPECD)by locating the herniated cervical disc through brachial plexus magnetic resonance neurography(MRN).Methods Thirty-nine patients with cervical spondylotic radiculopathy(CSR)who underwent PPECD were divided into MRN group and conventional group according to whether brachial plexus MRN was performed before operation.There were 18 patients in MRN group and 21 patients in control group.The operation time,bleeding volume,fluoroscopy times during operation,incidence of upper limb numbness and muscle weakness after operation,the longest diameter of left and right bone window and the longest diameter of upper and lower bone window were recorded.The VAS and JOA value of preoperative,postoperative,6 months after operation and 12 months after operation were compared between the two groups.C2~C7 Cobb angle,height of intervertebral space at operative level were recorded.Results The operation time,intraoperative bleeding volume,intraoperative fluoroscopy times in the MRN group were better than those in the conventional group(P<0.001).The changes of JOA value,VAS value and C2~C7 Cobb angle in 6 months and 12 months after operation were significantly improved compared with those before operation(P<0.05).Conclusion Preoperative brachial plexus MRN precise location of cervical disc herniation could reduce the damage to zygapophysial joint and other structures caused by grinding bone window in PPECD,avoid the injury of cervical nerve and dura mater caused by searching for herniated cervical intervertebral disc,reduce intraoperative bleeding,fluoroscopy times and operation time,and obtain the best result with less trauma.Surgical effect,operation safety is higher,patients recover faster after operation.
作者
黄镇
李岳飞
毕经纬
任佳彬
李瑞
刘鑫
孙宁
孙兆忠
HUANG Zhen;LI Yuefei;BI Jingwei;REN Jiabin;LI Rui;LIU Xin;SUN Ning;SUN Zhaozhong(Department of Spinal Surgery,Binzhou Medical University Hospital,Binzhou 256603,Shandong,P.R.China)
出处
《滨州医学院学报》
2020年第1期19-22,共4页
Journal of Binzhou Medical University
基金
山东省自然科学基金资助项目(ZR2017LH021)
国家重点研发计划(2017YFC0114002)
滨州医学院科技计划项目(BY2018KJ03)
关键词
经皮颈椎后路内镜颈椎间盘切除术
磁共振
颈椎病
posterior percutaneous endoscopic cervical discectomy
magnetic resonance imaging
cervical spondylosis
