经皮射频消融术治疗神经根型颈椎病的疗效分析

摘要

[目的]探讨经皮射频消融髓核成形术治疗神经根型颈椎病的疗效及安全性.[方法]2008年1月至2010年8月应用经皮射频消融髓核成形术治疗神经根型颈椎病患者27例,比较术前、术后2周及末次随访时的疼痛视觉模拟评分(VAS)和颈部功能障碍指数(NDI),评估临床结果,以及影像学检查颈椎间盘突出、椎体间不稳定等情况,并记录手术并发症.[结果]27例患者总共手术椎间隙37个,其中单节段19例,双节段6例,三个节段2例.随访时间1年～28个月,平均19.8个月.未发现手术节段出现不稳定,未发现手术节段椎间隙出现塌陷.27例患者平均VAS评分为术前(7.84±1.47)分,术后2周减少到(2.44±1.61)分,末次随访为(3.16±1.17)分.平均NDI术前为(61.15±15.71)％,术后2周减少到(16.48±13.29)％,末次随访为(14.42±11.55)％.术后2周及末次随访VAS评分及NDI评分均较术前有显著改善,差异均有统计学意义(P＜0.05).无1例患者出现脊髓、神经、大血管损伤及术后感染等并发症；无患者出现脊膜破裂脑脊液漏;无患者出现术中刀头断裂.[结论]经皮射频消融髓核成形术是一种安全的微创手术,如果适应症选择正确,能够有效治疗神经根型颈椎病.%Objective To analyze the clinical outcome and safety of percutaneous nucleoplasty with radiofrenquency abrasion for treatment of cervical spondylotic radiculopathy. Methods From January of 2008 to December of 2010, 27 patients with cervical spondylotic radiculopathy received percutaneous nucleoplasty. The scores of visualrn( Continued on page 253)analog scale (VAS) and neck disability questionnaires (NDI) were evaluated before the operation, 2 weeks after the operation, and at the final follow-up. Furthermore, the herniation of intervertebral disk and intervertebral instability were monitored by imageological examination, and all of the intraoperative and postoperative complications were recorded. Results Percutaneous nucleoplasty in this study was performed on 27 patients and covered 37 inlerverlebral spaces. Of the 27 patients, 19 had nucleoplasty involving one segment of cervical vertebrae, 6 had nucleoplasty involving two segments, and 2 had nucleoplasty involving 3 segments. The follow-up lasted from one year to 28 months, averaged 19.8 months. Neither intervertebral instability or intervertebral collapse wa9 not found after the operation. The mean VAS score was 7. 84 ± 1.47 before the operation, decreased to 2. 44 ± 1.61 two weeks after the operation, and was 3. 16 ± 1. 17 at the final follow-up. NDI score was was (61. 15 ± 15. 71)% before the operation, decreased to (16. 48 ± 13. 29)% 2 weeks after the operation, and was (14. 42 ±11. 55) 96> at the final follow-up. VAS and NDI scores were improved 2 weeks after the operation and at the final follow-up, the differences being significant compared with those before the operation (P<0. 05). Neither intraoperative or postoperative complications occurred. Conclusion The percutaneous nucleoplasty has been proved to be an effective, minimally invasive and safe procedure for cervical spondylotic radiculopathy.