【摘要】 目的 探讨后路Delta通道内镜下髓核摘除术治疗颈椎间盘突出症的疗效。方法 采用后路Delta通道内镜下髓核摘除术治疗36例侧方型颈椎间盘突出症患者。记录术中开窗及神经减压情况、颈肩痛及上肢根性痛VAS评分、NDI、手术节段活动度、并发症发生情况。采用改良MacNab标准评价临床疗效。结果 患者均获得随访，时间6～17(11.3±1.8)个月。术后CT显示所有患者关节突骨质保留在50%以上，术后MRI均显示神经减压充分，无髓核组织残留。末次随访时颈椎DR片显示颈椎序列良好，未见颈椎不稳的发生。颈肩痛及上肢根性痛VAS评分、NDI:术后1 d、1个月、3个月及末次随访时均较术前改善(P<0.05),不同时间点之间比较差异均有统计学意义(P<0.05)。手术节段活动度术前、术后1个月、术后3个月及末次随访时比较差异均无统计学意义(P>0.05)。末次随访时，采用改良MacNab标准评价临床疗效：优25例，良8例，可3例，优良率为91.67%。术后2例残留颈肩部疼痛，2例上肢麻木加重，1例肌力较术前下降。结论 后路Delta通道内镜下髓核摘除术治疗颈椎间盘突出症，能够很好地解除神经压迫，缓解颈肩痛及上肢疼痛，促进功能恢复，避免脊柱融合术所致的颈椎节段功能丧失及邻椎病的发生。更多还原

【Abstract】 Objective To investigate the effect of posterior Delta channel microendoscopy discectomy in the treatment of cervical disc herniation.Methods The 36 patients with lateral cervical disc herniation were treated by posterior Delta channel microendoscopy discectomy.Intraoperative fenestration and nerve decompression, VAS of neck-shoulder pain and upper extremity root pain, NDI,range of motion of the operative segements and complications were recorded. The modified MacNab standard was used to evaluate the clinical efficacy.Results All patients were followed up for 6～17(11.3±1.8) months. Postoperative CT showed that more than 50% of the articular process bone was preserved in all patients, and postoperative MRI showed that nerve decompression was sufficient and no nucleus pulposus tissue remained. At the last follow-up, the cervical spine DR film showed that the cervical spine sequence was good, and no cervical spine instability was observed. The VAS of neck-shoulder pain and upper extremity root pain, NDI at 1 d, 1 month, 3 months after surgery and at the last follow-up were improved, compared with those before surgery(P<0.05), and the differences were statistically significant at different time points(P<0.05). There was no statistical difference in segmental motion before surgery, 1, 3 months after surgery and at the last follow-up(P>0.05). At the last follow-up, the modified MacNab standard was used to evaluate the clinical effect: The 25 cases were excellent, 8 were good, and 3 fair, with an excellent and good rate of 91.67%. Postoperative residual neck and shoulder pain occurred in 2 cases, upper limb numbness increased in 2 cases, and muscle strength decreased in 1 case.Conclusions Posterior Delta channel microendoscopy discectomy in the treatment of cervical disc herniation can relieve nerve compression, relieve neck and shoulder pain and upper limb pain, promote functional recovery, avoid cervical segmental function loss and adjacent vertebral disease caused by spinal fusion.更多还原