低温等离子髓核成形术治疗神经根型颈椎病的临床观察
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作者Author单位AddressE-Mail
陈广林 CHEN Guang-lin 南京中医药大学, 江苏 南京 210000
潍坊市中医院脊柱外科, 山东 潍坊 261041
Nanjing University of Traditional Chinese Medcine, Nanjing 210000, Jiangsu, China  
冯婷婷 FENG Ting-ting 潍坊市中医院脊柱外科, 山东 潍坊 261041  
徐世涛 XU Shi-tao 潍坊市中医院脊柱外科, 山东 潍坊 261041  
王进强 WANG Jin-qiang 潍坊市中医院脊柱外科, 山东 潍坊 261041  
谭磊 TAN Lei 潍坊市中医院脊柱外科, 山东 潍坊 261041  
马勇 MA Yong 南京中医药大学, 江苏 南京 210000 Nanjing University of Traditional Chinese Medcine, Nanjing 210000, Jiangsu, China  
黄桂成 HUANG Gui-cheng 南京中医药大学, 江苏 南京 210000 Nanjing University of Traditional Chinese Medcine, Nanjing 210000, Jiangsu, China hgc@njucm.edu.cn 
期刊信息:《中国骨伤》2018年,第31卷,第8期,第729-734页
DOI:10.3969/j.issn.1003-0034.2018.08.009
基金项目:山东省潍坊市科学技术发展计划(编号:2017YX011)
中文摘要:

目的:评估低温等离子髓核成形术治疗神经根型颈椎病的临床疗效并探讨其作用机制。

方法:2015年1月至2017年1月应用低温等离子髓核成形术治疗神经根型颈椎病21例,男8例,女13例;年龄43~61岁,平均49.6岁;病程1~6个月,中位数4个月;单节段病变3例,双节段9例,3节段7例,4节段2例。比较手术前后椎间盘压力、VAS评分;通过影像学资料测量手术椎体角度位移和椎体水平位移,观察颈椎的稳定性;采用改良MacNab评定标准评定疗效。

结果:20例患者均获得随访,时间6~12个月,平均8.6个月。术前及术后即刻椎间盘内压力分别为(32.0±5.26) cm H2O和(21.0±7.18) cm H2O,差异有统计学意义(P=0.003)。术前椎体角度位移、椎体水平位移为(3.85±1.26)°和(1.23±0.58) mm;术后6个月为(4.18±1.31)°和(1.69±0.46) mm,差异无统计学意义(P>0.05)。术后3 d、3个月和6个月VAS评分分别为3.51±0.49、2.63±0.61、2.56±0.71,较术前的7.49±0.53明显改善(P<0.05)。术后3 d、3个月、6个月采用改良MacNab评价疗效,优分别为6、10、12例,良分别为7、5、6例,可分别为4、3、1例,差分别为3、2、1例。术后6个月疗效优于术后3 d和术后3个月(P<0.05),术后3个月优于术后3 d (P<0.05)。

结论:低温等离子髓核成形术治疗神经根型颈椎病可以有效缓解颈肩臂痛,并可以缓解头痛、头晕等伴随症状。
【关键词】颈椎病,神经根型  伴随症状  经皮低温等离子髓核成形术
 
Clinical observation of percutaneous coblation nucleoplasty for the treatment of cervical spondylotic radiculopathy
ABSTRACT  

Objective:To evaluate the clinical effects of percutaneous coblation nucleoplasty in treating cervical spondylotic radiculopathy and investigate its mechanism of action.

Methods:Form January 2015 to January 2017,21 patients with cervical spondylotic radiculopathy were treated by percutaneous coblation nucleoplasty,including 8 males and 13 females with an average age of 49.6 years old ranging from 43 to 61 years old. The course of disease was for 1 to 6 months with a median age of 4 months. Three cases were single segment,9 cases were double segments,7 cases were three-segment,2 cases were four-segment. Intervertebral disc pressure,VAS were compared before and after operation. Angular displacement(AD) and horizontal displacement(HD) were measured by image data and in order to evaluate the cervical stability. Modified MacNab criteria was used to assess clinical effects.

Results:All the patients were followed up from 1 to 12 months with an average of 8.6 months. Preoperative intervertebral disc pressure was (32.0±5.26) cmH2O and immediately after operation was (21.0±7.18) cmH2O,there was statistical significance between before and after operation(P=0.003). Preoperative angular displacement and horizontal displacement was (3.85±1.26) ° and (1.23±0.58) mm,six months after operation was (4.18±1.31) ° and (1.69±0.46) mm,respectively. There was no statistical significance before and after operation(P>0.05). Preoperative VAS scores were 7.49±0.53,postoperative at 3 days,3,6 months were 3.51±0.49,2.63±0.61,2.56±0.71,respectively,and postoperative obtained obvious improvement(P<0.05). According to modified MacNab criteria,6 cases obtained excellent results,7 good,4 fair 3 poor at 3 days;10 cases obtained excellent results,5 good,3 fair,2 poor at 3 months; 12 cases obtained excellent results,6 good,1 fair,1 poor at 6 months after operation. Postoperative clinical effect at 6 months was better than 3 d,and 3 months(P<0.05),and postoperative at 3 months was better than 3 d(P<0.05).

Conclusion:Percutaneous coblation nucleoplasty in treating cervical spondylotic radiculopathy can effectively relieve the pain of neck,shoulder and upper limb and can also relieve some associated symptoms such as headache and dizziness.
KEY WORDS  Cervical spondylosis,radiculopathy  Associated symptoms  Percutaneous coblation nucleoplasty
 
引用本文,请按以下格式著录参考文献:
中文格式:陈广林,冯婷婷,徐世涛,王进强,谭磊,马勇,黄桂成.低温等离子髓核成形术治疗神经根型颈椎病的临床观察[J].中国骨伤,2018,31(8):729~734
英文格式:CHEN Guang-lin,FENG Ting-ting,XU Shi-tao,WANG Jin-qiang,TAN Lei,MA Yong,HUANG Gui-cheng.Clinical observation of percutaneous coblation nucleoplasty for the treatment of cervical spondylotic radiculopathy[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(8):729~734
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