摘要
目的 评价经颈椎间盘前外侧入路等离子消融联合后纵韧带前间隙注射胶原酶治疗神经根型颈椎病的疗效和安全性.方法 收集常州市第一人民医院疼痛科2021年3月至2022年3月收治的神经根型颈椎病患者40例,年龄20-75岁,单节段突出.在CT引导下经前外侧穿刺行责任颈椎间盘等离子消融10 s,随后调整穿刺针进入后纵韧带前间隙注射胶原酶300 IU.记录患者的手术操作时间、相关并发症,记录患者术前、术后1周及术后1、3、6个月视觉模拟评分(VAS)及颈椎功能障碍指数(NDI)评分,并在术后各时点进行改良MacNab标准疗效评定.结果 术后1、3、6个月的优良率均为95.0％(38/40例),较术后1周优良率[92.5％(37/40例)]高,差异均有统计学意义(P均＜0.05).术后各时点VAS、ND1评分均较术前明显降低(P均＜0.05).术中及术后均未见严重不良反应及并发症.结论 经颈椎间盘前外侧入路等离子消融联合后纵韧带前间隙胶原酶注射可安全、有效地治疗神经根型颈椎病.
Abstract
Objective To evaluate the efficacy and safety of cervical intervertebral disc plasma ablation through the anterolateral approach combined with collagenase injection into posterior longitudinal ligament through the anterior space in the treatment of patients with cervical spondylotic radiculopathy.Methods Forty patients with neurogenic cervical spondylosis,aged 20 to 75 years,single-segment prominence,admitted to the Department of Pain Medicine,Changzhou First People's Hospital,from March 2021 to March 2022,were collected.Plasma ablation in the responsible cervical disc was performed under CT guidance via anterolateral puncture for 10 s,and then collagenase 300 IU was injected into the posterior longitudinal ligament through the anterior space.The patients'operative time and related complications were recorded.Visual analogue scale(VAS),cervical dysfunction index(NDI)and modified MacNab criteria were recorded at 1 week,1 month,3 months,and 6 months after the treatment.Results The excellent and good rates of improved MacNab was all 95.0％(38/40 cases)at 1,3 and 6 months after the treatment,which was higher than that of 1 week[92.5％(37/40 cases),all P＜0.05].VAS and NDI scores were significantly lower at all time points after the treatment than pre-treatment(all P＜0.05).No serious adverse reactions or complications were observed during or after the treatment.Conclusion Plasma ablation through the anterolateral approach of cervical intervertebral disc combined with collagenase injection into the anterior space of posterior longitudinal ligament is a safe and effective method for the treatment of patients with cervical spondylotic radiculopathy.
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