目的 分析微创手术治疗椎间盘源性颈性眩晕患者的长期疗效。方法 2013-01至2016-07共28例(男13,女15)64个椎间盘:37～76 岁,平均55.3岁,病程中位数12.5个月,四分位数(2,51)个月;平均随访(79.5±11.0)个月。均经正规非手术治疗无效,根据病变椎间盘的退变情况,单纯椎间盘突出压迫脊髓或血管的并椎间稳定的选择低温等离子髓核成形术联合臭氧进行椎间盘减压、塑形;硬性压迫和椎间不稳的采用显微镜辅助零切迹自稳cage前路椎间减压植骨融合术。术前、术后1周、1个月及最后一次行功能查体,X线、CT、MRI检查,分别采用欧洲头晕评估量表(EEV),颈性眩晕症状与功能评分(CVSF)进行疗效评价并进行比较分析。结果 患者术后恢复良好,影像学检查椎间盘塑形良好、减压充分、椎间稳定;治疗后1周、1个月,末次随访EEV评分较术前明显降低(P＜0.05);和术后1周比,末次随访较术后1周降低(P＜0.05)。治疗后1周、1个月,末次随访三个时间点CVSF 评分较术前明显降低( P＜0.05);和术后1周比,末次随访降低 (P＜0.05)。结论 微创手术治疗椎间盘源性颈性眩晕长期效果良好,为临床治疗此类患者提供了一个比较微创、简洁、经济、有效的方法。
Abstract
Objective To analyze the long-term effect of minimally invasive surgery on cervical vertigo caused by the intervertebral disc.Methods Twenty-eight patients (13 males, 15 females and involving 64 discs) who were treated at our department between January 2013 and July 2016 were selected. These patients aged 37 to 76 , with an average age of 55.3. Their symptoms lasted 2 months to 20 years, median was 12.5 months,quartile was (2,51) months,and the average follow-up was(79.5±11.0)months. According to the degeneration of the intervertebral disc, coblation nucleoplasty combined with ozone was used to decompress and shape the disc if the disc protrusion compressed spinal marrow or blood vessels and the intervertebral space was stable. Anterior decompression and fusion with zero-notch self-stabilized cage were used for the treatment of rigid compression and intervertebral instability. Functional examination, X-ray, CT and MRI were performed before operation and 1 week, 1 month after surgery,and the final follow-up. The curative effect of cervical vertigo was evaluated and compared with the EEV and CVSF functional score.Results The patients recovered well after surgery, and the image examination showed that the intervertebral disc was in good shape, decompression was sufficient and that the intervertebral space was stable. At 1 week,1 month after surgery,and during the final follow-up, the EEV scores became significantly lower (P＜0.05) , especially during the final follow-up (P＜ 0.05), so were the CVSF scores.Conclusions Minimally invasive surgery has a good long-term effect on intervertebral discogenic cervical vertigo. This approach is minimally invasive, simple, inexpensive and effective.
关键词
微创手术 /
椎间盘源性 /
颈性眩晕
Key words
minimally invasive surgery /
discogenic /
cervical vertigo
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