侧路椎间孔镜髓核摘除术对腰椎间盘突出症患者术中出血量及术后血清PGE2和sTNF—RI水平变化的影响

Effects of lateral lumbar intervertebral fornixectomy on intraoperative bleeding volume and postoperative serum levels of PGE2 and sTNF-RI in patients with lumbar disc herniation

目的探究侧路椎间孔镜髓核摘除术（PTED）对腰椎间盘突出症患者术中出血量及术后血清前列腺素E2（PGE2）、可溶性肿瘤坏死因子I型受体（sTNF—RI）水平变化的影响。方法选取2013年10月至2016年8月本院腰椎间盘突出症患者86例，依据手术方案不同分组，各43例；对照组施行后路椎板间开窗髓核摘除术（FD）治疗，观察组施行PTED治疗；术后随访6个月，统计两组手术相关指标、手术效果，并对比两组手术前后疼痛程度（VAS）、功能障碍情况（ODI）、血清PGE2、sTNF—RI水平及生活质量变化情况。结果相较于对照组，观察组手术切口较小，术中出血量、术后卧床及住院时间均较少，差异均有统计学意义（均P〈0．05）；两组术前VAS、ODI及各维度生活质量评分差异均无统计学意义（均P〉0．05）；相较于对照组，观察组术后VAS、ODI评分均较低，各维度生活质量评分较高，差异均有统计学意义（均P〈0．05）；观察组优良率为93．02％（40／43），与对照组的88．37％（38／43）相比，差异无统计学意义（P〉0．05）；两组术前血清PGE2、sTNF—RI水平比较差异均无统计学意义（均P〉0．05）；相较于对照组，观察组术后血清PGE2水平较低，血清sTNF—RI水平较高，差异均有统计学意义（均P〈0．05）。结论PTED治疗腰椎间盘突出症，可减少术中出血量，降低术后血清PGE2水平，提高血清sTNF—RI水平，显著缓解患者术后疼痛，改善功能障碍程度，促进患者术后恢复，效果较为显著。

Objective To investigate the effects of lateral lumbar intervertebral fomixectomy （PTED） on intraoperative bleeding volume and postoperative serum levels of prostaglandin E2 （PGE2） and soluble tumor necrosis factor type I （sTNF-RI） receptor in patients with lumbar disc herniation. Methods From October, 2013 to August, 2016, 86 cases of lumbar disc herniation treated at our hospital were divided into a control group and an observation group according to different surgery plans, 43 cases for each group. The control group were treated with posterior laminectomy （FD） and the observation group with PTED. The patients were followed up for 6 months. The surgical-related indicators and surgical results were analyzed. The pain degree （VAS）, dysfunction （ODI）, serum levels of PGE2 and sTNF-RI, and quality of life of the two groups were compared before and after the treatment. Results Compared with the control group, the observation group had smaller incision, lower intraoperative bleeding volume, better postoperative bed rest, and shorter hospital stay （all P 〈 0.05）. There were no statistical differences in VAS, ODI, and quality of life scores between the two groups （all P 〉0.05）. The VAS and ODI scores of the observation group were lower than those of the control group, with statistical differences （all P 〈0.05）. There was no statistical difference in the excellent rate between the observation group （93.02%, 40/43） and the control group （88.37%, 38/43） （P 〉 0.05）. There were no statistical differences in the serum levels of PGE2 and sTNF-RI between the two groups before the treatment （both P 〉 0.05）. Compared with the control group, the level of serum PGE2 in the observation group was lower and the serum level of sTNF-RI was higher, with statistical differences （both P 〈0.05）. Conclusions PTED in the treatment of lumbar disc herniation can reduce the intraoperative bleeding volume, decrease the postoperative serum PGE2 level, increase the serum sTNF-RI level, significantly alleviate the patients＇ postoperative pain, improve the dysfunction degree, and promote the patients＇ postoperative recovery and has more significant effect.