The Comparative Study On The Effection Of Percutaneous Coblation Nucleoplasty And Collagenase Chemonucleolysis In The Treatment Of Patient With Cervical Spondylotic Radiculopathy

Objective1.To explore the effect of percutaneous coblation nucleoplasty combined with epidural block in the treatment of patient with cervical spondylotic radiculopathy.2.To explore the effect of collagenase chemonucleolysis combined with epidural block in the treatment of patient with cervical spondylotic radiculopathy.3.To explore the effect of epidural block in the treatment of patient with cervical spondylotic radiculopathy.MethodsFrom April 2015 to September 2016,I selected 90 cases of patients with cervical spondylotic radiculopathy in the hospital,according to the random grouping method divided the patients into three groups,including PCN group,collagenase group and the control group.Based on the drug therapy,the control group operated cervical epidural block;The PCN and collagenase group separately did the same operate after PCN and collagenase chemonucleolysis had done for 5 days.Three groups of subjects were in the hospital for 14 days,the curative effect of every participant was assessed by two physicians out of the study.To compare the preoperative NDI,VAS and YT of 90 patients with the instantly,1d,3d,7d,lmonth,3months ang 6months of the postoperative.The modified MacNab criteria is applied to the efficacy evaluation of the last follow-up.ResultsEvery surgery is well,the average time of an operation spent 30min.In PCN group,a patient had hoarseness after the surgery,because of excessive separation the sheath between viscera and arterial during the operation,and the recurrent laryngeal nerve was damaged.The patient returned to normal pronunciation by professional pronunciation training after 2 months of postoperative.In collagenase group,There was a patient appeared severe pain symptoms of the neck and upper limb after the surgery,and the symptoms gradually relieved due to intravenous infusion of mannitol,dexamethasone injection 3days.Other symptoms didn’t happened,such as nerve injury,discitis,hemorrhage in the postoperation.All patients received 6 months follow-up.In the preoperation,there was no significant difference in VAS,NDI,YT grade of the subject in three groups.The difference wasn’t statistically significant(P>0.05).To compare with the preoperative in the PCN group,the NDI,VAS decreased,and the YT increased in the each point of the postoperative.The difference was statistically significant(P<0.01).The excellent of MacNab criteria was 83.33%(25/30).To compare with the preoperative in the collagenase group,the NDI,VAS decreased,and the YT increased in 7d,lm,3m,6m of the postoperative.The difference was statistically significant(P<0.05).The excellent of MacNab criteria was 90%(27/30).The curative effect in PCN group is better than collagenase group in the instantly,Id,3d,7d of the postoperative.The difference was statistically significant(P<0.01).The curative effect in PCN group compared with collagenase group in the lm,3m and 6m of the postoperative.The difference wasn’t statistically significant(P>0.05).Conclusion1.The short and medium-term efficacy of percutaneous coblation nucleoplasty in the treatment of patient with cervical spondylotic radiculopathy is well,and it has the advantages of simple operation,high safety,small wound,quick recovery and good curative effect.2.The treatment of patient with cervical spondylotic radiculopathy with the collagenase chemonucleolysis also has a good medium-term clinical effect,but it is slow to work and the risk of treatment is high.3.The effection of cervical epidural block in the treatment of patient with cervical spondylotic radiculopathy is well for the short term,but the curative effect is poor in the medium and long term.