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Title: [Percutaneous endoscopic Key-Hole technology for treatment of paracentral cervical disc herniation].
Author: Liu G, Cao Q, Tang G, Zhang J.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2020 Jul 15; 34(7):895-899. PubMed ID: 32666735.
Abstract:
OBJECTIVE: To investigate the effectiveness of percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation in the treatment of paracentral cervical disc herniation. METHODS: Between December 2015 and October 2018, 29 cases of paracentral cervical disc herniation were treated with percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation. There were 16 males and 13 females, with an average age of 49.7 years (range, 39-78 years). The disease duration was 3.5-15.0 months (mean, 6.2 months). The herniated disc located at C _{3, 4} in 2 cases, C _{4, 5} in 5 cases, C _{5, 6} in 9 cases, C _{6, 7} in 12 cases, and C ₇, T ₁ in 1 case. The main symptoms were radiculopathy symptom. The operation time, intraoperative blood loss, hospital stay, and complications were observed and recorded. Visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, cervical range of motion (ROM), Macnab standard, and cervical segment stability were used to evaluate the efficacy and safety of the operation. RESULTS: All patients were followed up 11-43 months, with an average of 19.4 months. The operation time was 67-89 minutes (mean, 73.3 minutes); the intraoperative blood loss was 18-30 mL (mean, 22.9 mL); the hospital stay was 5-10 days (mean, 7.3 days). All the incisions healed by first intention. There was 1 case of hypodynia and hyperalgesia in the affected limb after operation,1 case of decreased limb muscle strength. The VAS scores and JOA scores at each time point after operation were superior to those before operation ( P<0.05). There was no significant difference between the time points after operation ( P>0.05). At last follow-up, the effectiveness was rated according to the Macnab standard as excellent in 11 cases, good in 15 cases, fair in 2 cases, and bad in 1 case, with an excellent and good rate of 89.7%. The CT and MRI showed the decompression of spinal canal and nerve canal. There was no significant difference in cervical ROM between pre- and post-operation ( t=1.427, P=0.165), and no surgical segment instability occurred by X-ray films of flexion and extension of cervical vertebrae. CONCLUSION: For the paracentral cervical disc herniation with simultaneous compression of nerve roots and spinal cord, percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation has the advantages of small trauma, quick recovery, and satisfactory effectiveness, and can be used as a safe and effective minimally invasive procedure. 目的: 探讨经皮内镜下颈后路 Key-Hole 开窗减压髓核摘除术治疗旁中央型颈椎间盘突出症的疗效。. 方法: 2015 年 12 月—2018 年 10 月，应用经皮内镜下颈后路 Key-Hole 开窗减压髓核摘除术治疗旁中央型颈椎间盘突出症患者 29 例。男 16 例，女 13 例；年龄 39～78 岁，平均 49.7 岁。病程 3.5～15.0 个月，平均 6.2 个月。病变节段：C _3、4 2 例，C _4、5 5 例，C _5、6 9 例，C _6、7 12 例，C ₇、T ₁ 1 例。患者以神经根性症状为主。记录手术时间、术中出血量、住院时间及手术并发症，采用疼痛视觉模拟评分（VAS）、日本骨科协会（JOA）评分、Macnab 疗效评价标准以及颈椎活动度（range of motion，ROM）、手术节段稳定性来评估手术疗效及安全性。. 结果: 患者均获随访，随访时间 11～43 个月，平均 19.4 个月。手术时间 67～89 min，平均 73.3 min；术中出血量 18～30 mL，平均 22.9 mL；住院时间 5～10 d，平均 7.3 d。术后切口均Ⅰ期愈合。术后出现 1 例患肢触觉减退、痛觉过敏，1 例四肢肌力下降。术后各时间点 VAS 评分及 JOA 评分均较术前明显改善，差异有统计学意义（ P<0.05）；术后各时间点间比较，差异均无统计学意义（ P>0.05）。末次随访时，按照 Macnab 评定标准评价疗效，获优 11 例、良 15 例、可 2 例、差 1 例，优良率为 89.7%。CT、MRI 复查显示椎管及神经根管充分减压；颈椎屈伸动力位 X 线片测量颈椎 ROM 手术前后差异无统计学意义（ t=1.427， P=0.165），均未出现手术节段失稳情况。. 结论: 对于同时压迫神经根和脊髓的旁中央型颈椎间盘突出症，经皮内镜下颈后路 Key-Hole 开窗减压髓核摘除术具有创伤小、恢复快、疗效满意等优点，可作为一种安全、有效的微创术式。.

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