经皮椎间孔镜髓核摘除术配合康复治疗腰椎间盘突出症的临床研究分析

Clinical Analysis of Percutaneous Transforaminal Endoscopic Discectomy Combined with Rehabilitation in the Treatment of Lumbar Disc Herniation

目的:探讨经皮椎间孔镜腰椎髓核摘除术(PTED)配合康复训练治疗腰椎间盘突出症(LDH)的临床疗效以及相关因素分析。方法:选取2014年10月至2016年10月本院收治的LDH患者50例,行PTED手术联合围手术期至术后6个月康复训练治疗。观察比较手术前后患者VAS评分、SAS评分、ODI指数及SF-36评分;检测并比较手术前后血清IL-1β、MMP-3、TNF-α水平;对影响治疗效果的临床参数进行单因素分析。结果:治疗后优12例,良18例,可17例,差3例,总有效率为94.00%。与术前比较,术后1d VAS、SAS评分及ODI指数升高,SF-36评分降低(P<0.05或P<0.01);术后1个月至术后6个月VAS、SAS评分及ODI指数呈降低趋势,SF-36评分呈升高趋势(P<0.05或P<0.01)。与术前比较,术后血清IL-1β、MMP-3及TNF-α水平均明显降低(P<0.01)。将优和良患者归为预后良好组(n=30),将可和差患者归为预后不佳组(n=20),经单因素分析,年龄、病程与患者术后临床疗效存在显著相关性(P<0.05)。结论:PTED联合康复训练治疗LDH的疗效显著,可明显降低患者术后疼痛感、缓解焦虑心情,促进腰椎功能恢复,抑制机体炎症反应,提高患者术后生活质量,同时患者年龄、病程可影响其临床治疗效果。

Objective: To investigate the clinical efficacy and related factors of percutaneous transforaminal lumbar discectomy( PTED) combined with rehabilitation training in the treatment of lumbar disc herniation( LDH). Methods: 50 patients with LDH admitted to our hospital from October 2014 to October 2016 were treated with PTED and perioperative period to 6 months postoperative rehabilitation. The VAS score,SAS score,ODI index and SF-36 score were observed and compared before and after the operation. Serum levels of IL-1β,MMP-3 and TNF-α were measured and compared before and after operation; Univariate analysis was used to analyze the clinical parameters affecting the therapeutic effect. Results: After treatment,12 cases were excellent,good in 18 cases,fair in 17 cases and poor in 3 cases,the total effective rate was 94.00%. Compared with preoperative,VAS,SAS score and ODI index increased 1 d after operation,and the SF-36 score decreased( P < 0. 05 or P < 0. 01); the SAS,VAS score and ODI index showed a decreasing trend from 1 months to 6 months after operation and the SF-36 score showed an increasing trend( P < 0. 05 or P < 0. 01).Compared with the preoperative,serum IL-1β,MMP-3 and TNF-α levels were significantly lower( P < 0.01). Excellent and good patients were classified as good prognosis group( n = 30),fair and poor patients were classified as poor prognosis group( n = 20),there was a significant correlation between the age and the course of disease and the clinical curative effect( P <0.05). Conclusion: PTED combined with rehabilitation training can significantly reduce the postoperative pain,relieve anxiety,promote the recovery of lumbar function,inhibit the inflammatory response and improve the quality of life of patients. At the same time,the patient's age,course of disease can affect the clinical treatment effect.