后路椎间盘镜手术对腰椎间盘突出症患者效果及对创伤反应的研究

Effect of posterior intervertebral disc surgery for patients with lumbar intervertebral disc protrusion and its influence on trauma reactions

目的探讨后路椎间盘镜手术对PLID患者的临床效果及对创伤的影响。方法以2015-01-2016-01在我院接受后路椎间盘镜手术治疗的84例PLID患者为研究对象,随机分为研究组和对照组,各42例。研究组行后路椎间盘镜手术治疗,对照组行开放椎板开窗手术治疗。对2组手术时间、出血量及住院时间进行记录,比较2组术前及术后3月、术后6月、术后24月下肢VAS评分、ODI评分、腰椎JOA评分,采用ELISA法测定2组治疗前及术后1周血清IL-1β、PGE2、MMP-3、IFN-γ水平。结果研究组在手术时间、术中出血量及住院时间上均优于对照组(P<0.05)。与术前对比,2组术后3月、6月、24月腰痛VAS评分、ODI评分均降低,而JOA评分均增高(P<0.05),但2组间比较则没有明显差别(P>0.05)。与术前对比,2组术后1周血清IL-1β、PGE2、IFN-γ及MMP-3水平均降低,且研究组降低更著(P<0.05)。结论后路椎间盘镜手术对PLID效果显著,对机体创伤小,可有效降低机体炎症反应,有利于术后恢复,具有很好的临床应用价值。

Objective To investigate the clinical effect of posterior discectomy on PLID patients and its influence on trauma. Methods From January 2015 to January 2017, 84 patients with PLID in our hospital who accepted the posterior intervertebral disc mirror surgical treatment were selected as the research subjects. The patients were randomly divided into research group and the control group,42 cases in each group. The research group received posterior intervertebral disc mirror surgery, the control group received open lamina windowing operation. The operation time, blood loss and hospital stay were recorded. The lower limb VAS score, ODI score, lumbar JOA score were compared in two groups at preoperation and postoperative 3, 6, 24 months. The serum IL-1β, PGE2, MMP-3, IFNγlevels were detected by ELISA method before treatment and postoperative 1 week. Results The operation time, blood loss and hospitalization time of the study group were better than those of the control group（P〈0.05）. Compared with preoperation, the VAS scores and ODI scores decreased in the two groups after 3, 6 and 24 months of operation, while the JOA score was increased（P〈0.05）, but there was no significant difference between the two groups（P〈0.05）. Compared with preoperation, at postoperative 1 week, serum IL-1β, PGE2, IFN-γ and MMP-3 levels in two groups were decreased,and those of the study group decreased more significantly（P〈0.05）. Conclusion Posterior disc mirror surgery is effective for PLID, has less trauma to the body, can effectively reduce the inflammatoryresponse of the body, and is conducive to postoperative recovery, has good clinical value.