摘要
目的 分析神经根型颈椎病患者行后路经皮脊柱内镜下手术效果及疗效影响因素.方法 前瞻性选择2022年1月至2023年1月安康市人民医院收治的108例神经根型颈椎病患者作为研究对象,按照随机数字表法将其分为观察组和对照组,每组各54例.观察组行后路经皮脊柱内镜下手术治疗,对照组行前路颈椎间盘切除融合术治疗.比较两组手术情况、术前1 d及术后6个月、12个月的颈椎功能障碍指数(NDI)、颈部疼痛视觉模拟评分法(VAS)、颈椎生理曲度、病变椎间高度及临床疗效.使用单因素和多因素Logistic回归分析疗效的影响因素.结果 观察组的手术时间、首次下床时间、术后住院时间分别为(74.43±14.17)min、(18.08±2.49)h、(3.62±0.83)d,均短于对照组[(88.76±18.52)min、(26.26±5.71)h、(6.41±1.38)d],观察组术中出血量为(14.24±4.83)mL,少于对照组[(76.81±16.08)mL],差异均有统计学意义(P＜0.05).术后6、12个月,两组NDI指数、颈部VAS评分均较术前降低,且观察组术后6个月的NDI指数、颈部VAS评分分别为(12.01±2.13)％、(1.61±0.60)分,均小于对照组[(14.27±2.69)％、(1.92±0.85)分],差异均有统计学意义(P＜0.05);两组术后12个月的NDI指数、颈部VAS评分比较,差异均无统计学意义(P＞0.05).术后6、12个月,对照组颈椎生理曲度、病变椎间高度均较术前升高,差异均有统计学意义(P＜0.05),观察组颈椎生理曲度、病变椎间高度较术前比较,差异均无统计学意义(P＞0.05);观察组术后6、12个月的颈椎生理曲度分别为(9.50±3.14)°、(9.83±3.21)°,病变椎间高度分别为(4.78±0.82)、(4.75±0.88)mm,均小于对照组[(16.46±5.17)°、(14.79±4.52)°和(6.89±1.15)、(6.60±1.15)mm],差异均有统计学意义(P＜0.05).观察组和对照组疗效优良率比较(88.89％vs.85.19％),差异无统计学意义(P＞0.05).根据108例患者的疗效分组,疗效良好组共94例,疗效不佳组共14例.疗效良好组与疗效不佳组的年龄、病程、吸烟、术中出血量、运动锻炼占比比较,差异均有统计学意义(P＜0.05).经多因素Logistic回归分析,年龄、吸烟和运动锻炼均是神经根型颈椎病患者术后疗效的独立影响因素(P＜0.05).结论 神经根型颈椎病患者行后路经皮脊柱内镜下手术效果确切,有助于减轻手术创伤,而疗效受年龄、吸烟和运动锻炼的影响,值得临床予以重视.
Abstract
Objective To analyze the effect and influencing factors of posterior approach percutaneous spinal endoscopic surgery in pa-tients with radiculopathy.Methods A total of 108 patients with cervical radiculopathy admitted to Ankang People's Hospital from January 2022 to January 2023 were prospectively selected as the study subjects,and they were divided into the observation group and the control group according to the random number table method,with 54 cases in each group.The observation group underwent posterior percutaneous spinal endoscopic surgery,and the control group underwent anterior cervical discectomy and fusion.The surgical conditions,neck disability index(NDI),visual analogue score(VAS)of neck pain,physiological curvature of cervical spine,intervertebral height of lesions at 1 day before operation,6 months and 12 months after operation,and clinical efficacy were compared between the two groups.The influencing factors of efficacy was analyzed using univari-ate,multivariate Logistic regression analysis.Results The operation time,first time to get out of bed,and postoperative hospital stay in the ob-servation group were(74.43±14.17)min,(18.08±2.49)h,and(3.62±0.83)d,respectively,which were shorter than those in the control group[(88.76±18.52)min,(26.26±5.71)h,(6.41±1.38)d],the intraoperative blood loss was(14.24±4.83)mL,which was less than that in the control group[(76.81±16.08)mL],and the differences were statistically significant(P＜0.05).At 6 and 12 months after operation,the NDI index and neck VAS score of the two groups were lower than those before operation,and the NDI index and neck VAS score of the observation group at 6 months after operation were(12.01±2.13)％and(1.61±0.60)points,respectively,which were lower than those of the control group[(14.27±2.69)％,(1.92±0.85)points],the differences were statistically significant(P＜0.05).There were no statis-tically significant differences in NDI index and neck VAS score between the two groups at 12 months after operation(P＞0.05).At 6 and 12 months after operation,the vertebral physiological curvature and intervertebral height of the lesion in the control group were higher than those before operation,and the differences were statistically significant(P＜0.05).There were no statistically significant differences in the physiological cur-vature of the vertebral body and the height of the diseased intervertebral space in the observation group(P＞0.05).The cervical physiological curvature of the observation group at 6 and 12 months after operation were(9.50±3.14)° and(9.83±3.21)°,and the intervertebral height of the lesions were(4.78±0.82)and(4.75±0.88)mm,which were smaller than those of the control group[(16.46±5.17)°,(14.79±4.52)° and(6.89±1.15)mm,(6.60±1.15)mm],the differences were statistically significant(P＜0.05).There was no statistically sig-nificant difference in the excellent and good rate between the observation group and the control group(88.89％vs.85.19％)(P＞0.05).Ac-cording to the curative effect of 108 patients,there were 94 cases in the good efficacy group and 14 cases in the poor efficacy group.There were statistically significant differences in age,course of disease,smoking,intraoperative blood loss,and proportion of exercise between the good effica-cy group and the poor efficacy group(P＜0.05).Multivariate Logistic regression analysis showed that age,smoking and exercise were independ-ent influencing factors for postoperative efficacy in patients with cervical radiculopathy(P＜0.05).Conclusion For patients with cervical spon-dylosis of nerve root type line through skin after spinal endoscopic surgery effect is exact,helps to reduce the surgical trauma,and curative effect is influenced by age,smoking and exercise,worth clinical attach importance to it.
维普
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