MIS-TLIF单侧椎弓根固定术对单节段腰椎间盘突出症TNF-α、IL-1β表达的影响

Effect of MIS-TLIF unilateral pedicle screw fixation on the expression of TNF-α and IL-1β in patients with lumbar intervertebral disc herniation

目的研究微创经椎间孔腰椎体间融合术(MIS-TLIF)单侧椎弓根固定对单节段腰椎间盘突出症(LDH)患者肿瘤坏死因子-α(TNF-α)和白细胞介素-1β(IL-1β)表达水平的影响。方法纳入206例单节段LDH患者作为研究对象,随机抽签分为两组,各103例。观察组行MIS-TLIF单侧椎弓根固定术,对照组行后路腰椎椎间融合术(PLIF)。随访半年,记录两组手术前后外周血TNF-α和IL-1β炎性因子水平,比较两组术后Oswestry功能障碍指数(ODI)、术后复发及并发症发生情况,分析炎性因子水平与ODI、术后复发及并发症的关系。结果观察组术后1周ODI显著低于对照组(P<0.05),末次随访时两组评分无显著性差异(P>0.05)。观察组术后1周时TNF-α和IL-1β水平均显著低于对照组(P<0.05)。观察组术后并发症总发生率和复发率均显著低于对照组(P<0.05)。经偏相关分析显示,OID评分与TNF-α相呈显著正相关(r=0.479,P=0.000),OID评分与IL-10呈显著正相关(r=0.190,P=0.006)。ROC显示TNF-α和IL-1β对术后复发和并发症发生率有一定预测价值(曲线下面积为0.765,0.752,P<0.001)。结论 MIS-TLIF用于治疗LDH能促进患者术后早期康复,减轻术后炎性反应,降低术后并发症和复发率,术后加强TNF-α和IL-1β者炎性因子监测对防治复发和并发症有一定指导价值。

Objective To study the influence of minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF） with unilateral pedicle screw fixation on the expression of tumor necrosis factor alpha （TNF-α） in patients with LDH.Methods 206 patients with single segment LDH in our hospital were randomly divided into 2 groups,103 cases in each group.The observation group received the MIS-TLIF unilateral pedicle screw fixation,the control group underwent posterior lumbar interbody fusion （PLIF）.The levels of TNF-α and IL-1β in peripheral blood of two groups were recorded after six months of follow-up,the Oswestry dysfunction index （ODI）,postoperative recurrence and complications were compared between the two groups.The relationship between the level of inflammatory factors and ODI,postoperative recurrence and complications were analyzed.Results The ODI of the observation group was significantly lower than that of the control group at 1 weeks after operation （P＆lt;0.05）.There was no significant difference between the two groups at the last follow-up （P＆gt;0.05）.The levels of TNF-α and IL-1 in the observation group were significantly lower than those in the control group at 1 weeks after operation （P＆lt;0.05）,the incidence of postoperative complications and recurrence rate in the observation group were significantly lower than those in the control group （P＆lt;0.05）.The partial correlation analysis showed that OID score was positively correlated with TNF-α signify （r=0.479,0.190,P=0.000,0.006）.The results of ROC showed that TNF-α and IL-1 could predict the incidence of postoperative recurrence and complications （AUC=0.765,0.752,P＆lt;0.001）.Conclusion The MIS-TLIF used in LDH can promote early postoperative rehabilitation,reduce postoperative inflammatory response,postoperative complications and recurrence rate.To strengthen the monitoring of inflammatory factors of TNF-α and IL-1β after operation,which is helpful for guiding the prevention and treatment of recurrence and complications.