单节段神经根型颈椎病经皮颈椎后路内镜下治疗后颈椎曲度变化及其影响因素分析
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赤峰市医院 脊柱外科,内蒙古 赤峰 024099

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Analysis of changes in cervical curvature and influencing factors after percutaneous posterior cervical endoscopic treatment for single segment cervical spondylotic radiculopathy
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Department of Spine Surgery, Chifeng Municipal Hospital, Chifeng, Inner Mongolia 024099, China

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    摘要:

    目的 探讨单节段神经根型颈椎病经皮颈椎后路内镜下治疗后颈椎曲度变化及其影响因素。方法 选取2021年1月-2024年3月该院收治的单节段神经根型颈椎病患者200例,根据随机数表法分为对照组和研究组。对照组采用传统开放颈椎前路手术治疗,研究组采用经皮颈椎后路内镜下治疗,比较两组患者治疗效果、手术相关情况、颈椎曲度及其他颈椎矢状位参数情况、疼痛情况和颈椎功能,采用广义估计方程(GEE)模型,分析两种方法对颈椎曲度和其他颈椎矢状位参数的改善程度,并分析影响颈椎曲度变化的危险因素。结果 研究组手术时间、切口长度和住院时间明显短于对照组,术中出血量和住院费用明显少于对照组,差异均有统计学意义(P < 0.05)。研究组优良率明显高于对照组,差异有统计学意义(P < 0.05)。研究组C2-7 Cobb角和T1倾斜角明显大于对照组,椎间隙高度明显高于对照组,C2-7矢状面垂直轴(C2-7 SVA)明显小于对照组,差异均有统计学意义(P < 0.05)。两组患者术后3个月和末次随访时视觉模拟评分法(VAS)评分和颈椎功能障碍指数(NDI)明显低于术前,且研究组明显低于对照组,两组患者术后3个月和末次随访时日本骨科协会(JOA)评分明显高于术前,且研究组明显高于对照组,差异均有统计学意义(P < 0.05);椎间隙高度 ≤ 8 mm(OR^ = 1.627,95%CI:1.401~1.938,P = 0.020)、T1倾斜角 ≤ 25°(OR^ = 1.598,95%CI:1.381~1.934,P = 0.027)、未采用经皮颈椎后路内镜下治疗(OR^ = 2.591,95%CI:1.673~3.998,P = 0.000)为影响颈椎曲度变化的独立危险因素,C2-7 SVA ≤ 20 cm(OR^ = 0.748,95%CI:0.601~0.928,P = 0.007)为颈椎曲度变化的保护因素,经GEE可见,研究组对C2-7 Cobb角、椎间隙高度、T1倾斜角和C2-7 SVA的改善情况明显优于对照组,差异均有统计学意义(P < 0.05)。结论 经皮颈椎后路内镜下治疗,能明显改善单节段神经根型颈椎病患者的颈椎曲度及其他颈椎矢状位参数情况,治疗效果明显优于传统开放颈椎前路手术,且手术创伤小,住院费用少,住院时间短,术后康复快。值得临床推广应用。

    Abstract:

    Objective To explore the changes in cervical curvature and their influencing factors after percutaneous posterior cervical endoscopic treatment for single segment cervical spondylotic radiculopathy.Methods 200 patients with single segment cervical spondylotic radiculopathy from January 2021 to March 2024 was selected, then divide them into control group and study group according to the random number table method. The control group received traditional open anterior cervical surgery, while the study group received percutaneous posterior cervical endoscopic treatment. Compare the treatment outcomes, surgical related conditions, cervical curvature and other sagittal parameters, pain levels, and cervical function between the two groups of patients. Using the generalized estimation equation (GEE) model to analyze the improvement degree of cervical curvature and other cervical sagittal parameters by two methods, and analyze the risk factors affecting changes in cervical curvature.Results The study group had significantly shorter surgical time, incision length, and hospitalization time compared to the control group. The intraoperative blood loss and hospitalization costs were also significantly lower than those of the control group, and the differences were statistically significant (P < 0.05). The excellent rate of the study group was significantly higher than that of the control group, and the difference was statistically significant (P < 0.05). The C2-7 Cobb angle and T1 tilt angle in the study group were significantly higher than those in the control group, the intervertebral height was significantly higher than that in the control group, and the C2-7 sagittal vertical axis (C2-7 SVA) was significantly smaller than that in the control group, with statistically significant differences (P < 0.05). At three months after surgery and the last follow-up, the visual analogue scale (VAS) scores and neck disability index (NDI) of the two groups of patients were significantly lower than those before treatment, and the study group was significantly lower than the control group. At three months after surgery and the last follow-up, the Japanese Orthopaedic Association (JOA) scores of the two groups of patients were significantly higher than those before treatment, and the study group was significantly higher than the control group, with statistically significant differences (P < 0.05). Intervertebral height ≤ 8 mm (OR^ = 1.627, 95%CI: 1.401 ~ 1.938, P = 0.020), T1 tilt angle ≤ 25° (OR^ = 1.598, 95%CI: 1.381 ~ 1.934, P = 0.027), and no percutaneous cervical endoscopic treatment (OR^ = 2.591, 95%CI: 1.673 ~ 3.998, P = 0.000) were independent risk factors affecting changes in cervical curvature. C2-7 SVA ≤ 20 cm (OR^ = 0.748, 95%CI: 0.601 ~ 0.928, P = 0.007) was a protective factor for changes in cervical curvature. According to GEE, the improvement of C2-7 Cobb angle, intervertebral height, T1 tilt angle, and C2-7 SVA in the study group was significantly better than that in the control group, and the differences were statistically significant (P < 0.05).Conclusion Percutaneous posterior cervical endoscopic treatment can significantly improve the cervical cervical curvature and cervical sagittal plane parameters of patients with single segment cervical spondylotic radiculopathy, and the treatment effect is better than traditional open anterior cervical surgery. The surgical trauma is smaller, the cost is lower, the hospital stay is shorter, and the postoperative recovery is faster. It is worthy for clinical application.

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张海博,冷辉,贾一明.单节段神经根型颈椎病经皮颈椎后路内镜下治疗后颈椎曲度变化及其影响因素分析[J].中国内镜杂志,2025,31(5):21-31

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  • 收稿日期:2024-07-17
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  • 在线发布日期: 2025-06-11
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