射频消融髓核成形术治疗神经根型颈椎病疗效及相关因素分析-现代医学

射频消融髓核成形术治疗神经根型颈椎病疗效及相关因素分析

作者：黄凯华¹ 吴志浩¹ 常伟¹ 张子亮¹ 于慧华² 申璐璐² 王贯通¹ 孙强¹

单位：1. 南京医科大学附属南京医院(南京市第一医院)骨科, 江苏南京 210006;
2. 南京医科大学附属南京医院(南京市第一医院)放射科, 江苏南京 210006

分类号：R681.5

出版年·卷·期（页码）：2019·47·第六期（682-687）

摘要：

目的：观察射频消融髓核成形术治疗神经根型颈椎病的临床疗效，探讨影响疗效的相关因素。方法：回顾性分析2017年1月至2017年12月本院收治的72例神经根型颈椎病患者的临床资料，通过比较术前和术后不同时间点视觉模拟评分（VAS）、颈椎功能障碍指数（NDI）评估临床疗效，对比手术前后影像资料观察颈椎稳定性改变情况。对可能影响术后临床疗效的9种因素（年龄、性别、身体质量指数、病程、症状表现、椎间盘退变情况、是否合并椎管狭窄、手术时间、手术节段）进行单因素分析及多因素Logistic回归分析。结果：72例患者均顺利完成手术，手术时间15～50 min，平均28 min。与术前相比，患者术后各时间点的VAS评分显著降低（P<0.05），NDI指数显著提高（P<0.05）。末次随访时影像学表现与术前比较无明显差异（P>0.05）。依据改良MacNab标准评价末次随访疗效，优25例，良27例，可17例，差3例，优良率为72.2%。单因素分析显示，患者年龄、病程、症状表现、是否合并椎管狭窄、椎间盘退变情况等因素与疗效有显著性关系（P<0.05）；多因素分析显示独立危险因素为病程、症状表现。结论：射频消融髓核成形术治疗神经根型颈椎病手术时间短，疗效好，安全性高，值得临床推广应用。病程、症状表现为影响手术疗效的独立因素，临床上应加以重视。

Objective:To investigate the clinical efficacy of coblation nucleoplasty(CN)in the treatment of cervical spondylotic radiculopathy(CSR)and its influencing factors. Methods:72 cases of CSR admitted from January 2017 to December 2017 were followed both clinically[by visual analogue scal(VAS) and neck disabilitv index(NDI)] and radiographically. Univariate analysis as well as multivariate Logistic regression analysis was performed on 9 kinds of factors(age, gender, body mass index, course of disease, symptoms, intervertebral disc degeneration, cervical central canal stenosis or not, operation time, surgical segment) that may affect the clinical efficacy. Results:72 patients had been completed the operation successfully for an average of 28 minutes(15-50 min). Compared with pre-operation, the VAS scores after operations at different points of time were significantly reduced and the NDI scores were significantly improved (P<0.05). No difference was found in imaging findings compared with pre-operation (P>0.05). According to the modified MacNab criteria, 25 cases were excellent, 27 cases good, 17 cases fair and 3 cases poor, with excellent and good rate of 72.2%. Single factor analysis showed that the age, duration, symptoms, intervertebral disc degeneration, cervical central canal stenosis or not had significant correlation with the curative effect (P<0.05). Multivariate Logistic regression analysis showed that the independent factors were duration and symptoms.Conclusion:Coblation nucleoplasty has advantages of short operative time, reliable efficacy and high security in treatment of CSR, it is worth popularizing application clinically. Duration and symptoms as independent factors should be paid attention to.

参考文献：

[1] YADAV Y R,PARIHAR V,RATRE S,et al.Endoscopic decompression of cervical spondylotic myelopathy using posterior approach[J].Neurol India,2014,62(6):640-645.
[2] 王德利,李曙明,杨敏杰,等.神经根型颈椎病的解剖学基础及其进展[J].颈腰痛杂志,2001,4:332-334.
[3] KIM M W,LEE K Y,LEE S,et al.Factors associated with the symptoms of young adults with L5 spondylolysis[J].Asian Spine J,2018,12(3):476-483.
[4] BAKHTADZE M A,VERNON H,ZAKHAROVA O B,et al.The neck disability index-rusian language version (NDI-RU):a study of validity and reliability[J].Spine,2015,40(14):1115-1121.
[5] KUMAR N,ZAW A S,KUMAR N,et al.Annulo-nucleoplasty using disc-fx in the management of degenerative lumbar disc pathology:how long can the effect last?[J].Global Spine J,2018,8(4):365-373.
[6] YAMAMOTO Y,HARA M,NISHIMURA Y,et al.Hybrid method of transvertebral foraminotomy combined with anterior cervical decompression and fusion for multilevel cervical disease[J].Neurol Med Chir,2018,58(3):124-131.
[7] KOTHE R,SCHMEISER G,PAPAVERO L,et al.Open-door laminoplasty:what can the unilateral approach offer?[J].Oper Orthop Traumatol,2018,30(1):3-12.
[8] YOO H J,PARK J H,SEONG H Y,et al.Comparison of surgical results between soft ruptured disc and foraminal stenosis patients in posterior cervical laminoforaminotomy[J].Korean J Neurotrauma,2017,13(2):124-129.
[9] 谢侃,周云龙,朱宇,等.高节段神经根型颈椎病的诊治体会[J].现代医学,2017,45(6):842-845.
[10] 柳达,黄瑛,李彬,等.Mobi-C颈椎人工间盘置换治疗单节段颈椎间盘突出症的效果[J].东南大学学报(医学版),2013,32(5):554-559.
[11] Al-ZAIN F,LEMCKE J,KILEN T,et al.Minimally invasive spinal surgery using nucleoplasty:a 1-year follow-up study[J].Acta Neurochir,2008,150(12):1257-1262.
[12] FREEMAN B J,MEHDIAN R.Intradiscal electrothermal therapy,percutaneous discectomy,and nucleoplasty:what is the current evidence[J].Curr Pain Headache Rep,2008,12(1):14.
[13] YAN D L,LI J,ZHU H D.Percutaneous cervical nucleoplasty and percutaneous cervical discectomy treatments of the contained cervical disc herniation[J].Arch Orthop Trauma Surg,2010,130(11):1371-1376.
[14] O'NEILL C W,LIU J J,LEIBENBERG E,et al.Percutaneous plasma decompression alters cytokine expression in injured porcine intervertebral discs[J].Spine J,2004,4:88-98.
[15] KIM M K,SIM S E,KIM Y C,et al.Predictive factors of successful percutaneous cervical nucleoplasty for the treatment of pain with cervical herniated disk[J].World Neurosurg,2018,114:e654-e662.
[16] YANG B,XIE J,YIN B,et al.Treatment of cervical disc herniation through percutaneous minimally invasive techniques[J].Eur Spine J,2014,23(2):382-388.
[17] 胡义立,吴小涛,王锋.椎间盘生物学及细胞表型的研究进展[J].东南大学学报(医学版),2017,36(6):1040-1043.
[18] NARDI P V,CABEZAS D,CESARONI A.Percutaneous cervical nucleoplasty using coblation technology.Clinical results in fifty consecutive cases[J].Acta Neurochir Suppl,2005,92:73-78.

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