天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (2): 125-128.doi: 10.11958/20170077

• 专题研究-脊柱微创内镜（主编：徐宝山） • 上一篇    下一篇

颈前路内镜联合后路单开门治疗多节段椎管狭窄伴巨大椎间盘突出的临床分析

黎宁 1,2， 徐宝山 2△， 刘越 2， 杨强 2， 姜洪丰 2， 吉宁 2， 张春虹 2， 杨涛 2   

  1. 1 天津医科大学研究生院 （邮编 300070）； 2 天津市天津医院微创脊柱外科
  • 收稿日期:2017-01-18 修回日期:2017-01-25 出版日期:2017-02-15 发布日期:2017-02-14
  • 通讯作者: △通讯作者 E-mail: xubaoshan99@126.com E-mail:13785178992@126.com
  • 作者简介:黎宁 （1979）， 男， 博士在读， 副主任医师， 主要从事脊柱微创手术治疗方面研究
  • 基金资助:
    国家自然科学基金面上项目（31670983， 81272046）； 天津市自然科学基金（15JCYBJC25300）； 天津市卫计委攻关课题（14KG121）

Clinical analysis of APECD and ODLP in the treatment of multisegmental cervical stenosis and giant disc herniation

LI Ning1,2, XU Bao-shan2△, LIU Yue2, YANG Qiang2, JIANG Hong-feng2, JI Ning2, ZHANG Chun-hong2, YANG Tao2   

  1. 1 Graduate School of Tianjin Medical University, Tianjin 300070, China; 2 Department of Minimal Invasive Spine Surgery, Tianjin Hospital
  • Received:2017-01-18 Revised:2017-01-25 Published:2017-02-15 Online:2017-02-14
  • Contact: △Corresponding Author E-mail: xubaoshan99@126.com E-mail:13785178992@126.com

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摘要： 目的 探讨颈前路经皮内镜椎间盘切除术 （APECD） 联合后路单开门椎管扩大成形术 （ODLP） 治疗多节段椎管狭窄伴巨大椎间盘突出的临床疗效。方法 2016 年 9—11 月收治的多节段椎管狭窄伴巨大椎间盘突出患者 3 例， 男 2 例、 女 1 例， 年龄 56～61 岁。3 例患者均有明显肌力或感觉异常， 手术治疗先行 ODLP 使脊髓后移， 然后行 APECD。术前和术后分别进行疼痛视觉模拟评分 （VAS） 评估颈部和上肢疼痛情况， 颈椎功能障碍指数 （NDI） 评分评价神经功能改善情况。结果 本组患者术后 2 周疼痛程度和神经功能均较术前明显改善， 术中未发生颈髓损伤或血管损伤， 术后无切口感染、 血肿形成、 脑脊液漏、 吞咽困难、 声音嘶哑等并发症。结论 多节段椎管狭窄伴巨大椎间盘突出实施 APECD 联合 ODLP 治疗， 能够安全地进行神经减压并改善症状。APECD 能保留椎间盘和运动节段，虽然不能预防椎间盘退变， 但有利于延缓邻近节段的退变， 因此具有一定的临床意义。

关键词: 颈椎, 椎管狭窄, 颈椎病, 外科手术, 微创性, 椎间盘, 内镜, 椎板成形术

Abstract: Objective To investigate the effect of anterior percutaneous endoscopic discectomy (APECD) and opendoor laminoplasty (ODLP) through hybrid surgery in the treatment of multisegmental cervical stenosis and giant disc herniation. Methods This study involved 3 patients with multisegmental cervical stenosis and giant disc herniation confirmed by MRI. Among them, there were 2 males and 1 female, with ages from 56-61. All patients showed significant paresthesia or weakness, and were treated between September and November 2016. The surgery was performed by first the ODLP that made spinal cord back shift, and then APECD for the second step. The visual analog scale (VAS) and neck disability index (NDI) were assessed before and after operation. Results The VAS and NDI scores were improved two weeks after operation. No adverse events like spinal cord injury and vascular injury were found during the operation. After operation, no patients were found incision infection, hematoma formation, cerebrospinal fluid leakage, dysphagia, trachyphonia and so on. Conclusion The hybrid surgery of APECD and ODLP for the treatment of the multisegmental cervical stenosis and giant disc herniation can not only decompress the nerve safely and improve the function, but also preserve cervical intervertebral disc and motion segments, therefore delaying the degeneration of adjacent segments with clinical significance.

Key words: cervical vertebrae, spinal stenosis, cervical spondylosis, surgical procedures, minimally invasive, intervertebral disk, endoscope, laminoplasty