经皮后路脊柱内镜全可视化下多节段半椎板切除治疗颈椎管狭窄症的临床研究

Multilevel hemilaminectomy under fully-visualized percutaneous posterior spinal endoscopy for cervical spinal stenosis

摘要:

目的 探究颈椎管狭窄症（CS）患者应用颈后路脊柱内镜全可视多节段半椎板切除减压椎管扩大成形术的临床应用研究。方法 选取2023年8月—2024年12月新余市中医院收治的60例CS患者，采用随机数字表法将其分为对照组和治疗组，各30例。对照组采用后路单开门椎管扩大成形术进行治疗，治疗组采用颈后路脊柱内镜全可视多节段半椎板切除减压椎管扩大成形术进行治疗。比较两组围手术期指标、影像学评价指标、日本骨科协会（JOA）评分、颈椎功能障碍指数（NDI）评分、视觉模拟评分法（VAS）和并发症发生情况。结果 对照组手术时间、住院时间均长于治疗组（P <0.05），术中失血量大于治疗组（P <0.05）。治疗组JOA改善率高于对照组（P <0.05）。治疗组术后NDI、VAS评分均低于对照组（P <0.05）。术后两组NDI、VAS评分均较术前降低（P <0.05）。治疗组手术前后NDI、VAS评分的差值均大于对照组（P <0.05）。治疗组术后C₁～C₂ Cobb角均大于对照组（P <0.05）。术后两组C₁～C₂ Cobb角较术前增大（P <0.05），C₂～C₇ Cobb角较术前减小（P <0.05）。治疗组手术前后C₁～C₂ Cobb角、C₂～C₇ Cobb角的差值均大于对照组（P <0.05）。对照组与治疗组并发症总发生率比较，差异无统计学意义（P >0.05）。结论 颈后路脊柱内镜全可视多节段半椎板切除减压椎管扩大成形术能给CS患者带来明确疗效，该术式能缩短手术时间和住院时间，减少术中出血量，并有效改善症状，提高颈椎功能，有利于术后恢复。

Abstract:

Objective To investigate the clinical effect of multilevel hemilaminectomy under fully-visualized percutaneous posterior spinal endoscopy with spinal canal decompression and enlargement in patients with cervical spinal stenosis (CS).Methods Sixty cases of CS patients admitted to our hospital from August 2023 to December 2024 were selected and divided into 30 cases in the control group and 30 cases in the treatment group using a random number table. The control group underwent posterior open-door laminoplasty, and the treatment group was treated with multilevel hemilaminectomy under fully-visualized percutaneous posterior spinal endoscopy with spinal canal decompression and enlargement. The perioperative indicators, radiographic outcomes, Japanese Orthopaedic Association (JOA) scores, Neck Disability Index (NDI) scores, visual analog scale (VAS) scores, and incidence of complications were compared between the two groups.Results The control group had longer operative duration and length of hospital stay than the treatment group (P < 0.05), and intraoperative blood loss was greater in the control group than in the treatment group (P < 0.05). The JOA improvement rate in the treatment group was higher than that in the control group (P < 0.05). Postoperative NDI and VAS scores in the treatment group were lower than those in the control group (P < 0.05). Postoperative NDI and VAS scores in both groups were lower than preoperative scores (P < 0.05). The differences in NDI and VAS scores before and after surgery in the treatment group were greater than those in the control group (P < 0.05). The postoperative C₁～C₂ Cobb angle in the treatment group was greater than that in the control group (P < 0.05). Postoperative C₁～C₂ Cobb angles in both groups were larger than preoperative values (P < 0.05), while C₂～C₇ Cobb angles were smaller than preoperative values (P < 0.05). The differences in C₁～C₂ Cobb angles and C₂～C₇ Cobb angles before and after surgery in the treatment group were greater than those in the control group (P < 0.05). There was no statistically significant difference in the overall incidence of complications between the control group and the treatment group (P > 0.05).Conclusion Multilevel hemilaminectomy under fully-visualized percutaneous posterior spinal endoscopy with spinal canal decompression and enlargement provides definite clinical benefits for patients with CS, including shorter operative duration and length of hospital stay, reduced intraoperative blood loss, effective symptom relief, improved cervical function, and enhanced postoperative recovery.