7. 脊柱内窥镜微创手术治疗颈椎上睑下垂的临床研究

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100701

Xifeng Zhang MD, PhD

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引用次数: 0

摘要

背景背景/目的深入探讨脊柱内镜微创手术治疗颈椎后纵韧带骨化症的实际临床效果和安全性。研究设计/设置回顾性分析患者样本/结局测量/方法回顾性分析我院2022年5月至2023年7月行脊柱内镜微创手术的39例颈椎OPLL患者的临床资料。其中男性32人，女性7人，平均年龄61.8岁。单节段手术18例，双节段手术10例，三节段手术7例，四节段手术2例，五节段手术1例，六节段手术1例。涉及两个或更少节段的手术在局麻下进行，而涉及三个或更多节段的手术在全身麻醉下进行。记录手术时间、术中出血量、住院时间等指标。记录术前、术后症状、影像学特征、日本骨科协会（JOA）评分、疼痛视觉模拟评分（VAS）评分、颈椎功能障碍颈失能指数（NDI）评分，评价术前、术后神经功能改善情况及颈椎功能恢复情况。观察术后并发症的发生情况。结果局麻31例，全麻8例。3例多节段患者分阶段接受手术治疗。平均手术时间144.53±93.46 min，平均术中出血量[32.91±20.10]ml，平均住院时间7.06±3.82 d。术后长期随访显示术前JOA评分为10.25±2.06分，NDI评分为47.73±16.28分，VAS评分为5.10±1.42分。术后最终随访JOA评分为14.25±1.71分，NDI评分为20.75±13.55分，VAS评分为2.36±1.65分。与术前评分相比，这些评分在不同时间有显著差异。术后JOA评分较术前明显改善，NDI和VAS评分均明显下降。术后并发症2例出现C5神经根牵引症状，术后3个月内好转。2例患者术后症状改善不理想，建议进一步开放手术治疗，但均选择保守治疗。结论脊柱内窥镜微创手术治疗颈椎上睑下垂具有创伤小、恢复快、并发症少等优点。可有效改善患者神经功能和颈椎功能，但仍需严格把握手术指征，进一步积累临床经验，提高手术有效性和安全性。关键词：脊柱内镜；颈椎后纵韧带骨化；微创外科；颈椎病。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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7. A clinical study on the treatment of cervical OPLL with spinal endoscopic minimally invasive surgery

BACKGROUND CONTEXT

N/A

PURPOSE

To thoroughly investigate the practical clinical outcomes and safety of using spinal endoscopic minimally invasive surgery in the treatment of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine.

STUDY DESIGN/SETTING

A retrospective analysis

PATIENT SAMPLE

N/A

OUTCOME MEASURES

N/A

METHODS

A retrospective analysis was conducted on the clinical data of 39 patients with cervical OPLL who underwent spinal endoscopic minimally invasive surgery at our hospital from May 2022 to July 2023. Among them, 32 were male and 7 were female, with an average age of 61.8 years. There were 18 cases of single-segment surgery, 10 cases of double-segment surgery, 7 cases of triple-segment surgery, 2 cases of quadruple-segment surgery, 1 case of penta-segment surgery, and 1 case of hexa-segment surgery. Surgeries involving two or fewer segments were performed under local anesthesia, while surgeries involving three or more segments were performed under general anesthesia. Operation time, intraoperative blood loss, hospitalization time, and other indicators were recorded. The preoperative and postoperative symptoms, imaging features, Japanese Orthopaedic Association (JOA) score, visual analog score (VAS) score for pain, neck disability index (NDI) score for cervical dysfunction were recorded to evaluate the improvement of neurological function and recovery of cervical function before and after surgery. The occurrence of postoperative complications was also observed.

RESULTS

A total of 31 patients underwent local anesthesia and 8 patients underwent general anesthesia. Three patients with multiple segments underwent staged surgical treatment. The average operation time was 144.53±93.46 minutes, the average intraoperative blood loss was [32.91±20.10] milliliters, and the average hospitalization time was 7.06±3.82 days. Long-term follow-up after surgery showed that the preoperative JOA score was 10.25±2.06 points, the NDI score was 47.73±16.28 points, and the VAS score was 5.10±1.42 points. The postoperative final follow-up JOA score was 14.25±1.71 points, NDI score was 20.75±13.55 points, and VAS score was 2.36±1.65 points. There was a significant difference in these scores at different times compared to the preoperative scores. The postoperative JOA score improved significantly compared to the preoperative score, while both the NDI and VAS scores decreased significantly. Postoperative complications occurred in two patients with C5 nerve root traction symptoms, which improved within three months after surgery. Two patients had unsatisfactory postoperative symptom improvement and were recommended for further open surgical treatment, but they opted for conservative treatment instead.

CONCLUSIONS

Spine endoscopic minimally invasive surgery for the treatment of cervical OPLL has advantages such as small trauma, rapid recovery, and few complications. It can effectively improve patients' neurological function and cervical function, but it is still necessary to strictly grasp the surgical indication and further accumulate clinical experience to improve surgical effectiveness and safety. Keywords: spine endoscopy; ossification of the posterior longitudinal ligament of the cervical spine; minimally invasive surgery; cervical spondylosis.