经对侧椎间孔入路切除技术治疗高度游离腰椎间盘脱出的临床效果及其对基质金属蛋白酶3表达水平影响研究

Effects of Transforaminal Lumbar Discectomy via Contralateral Approach on Treatment Sequestered Lumbar Disc Herniation and It's the Expression of MMP-3

目的探讨经对侧椎间孔入路切除技术治疗高度游离腰椎间盘脱出的临床效果及其对基质金属蛋白酶3(MMP-3)表达水平的影响。方法选择2012年1月—2017年2月在河北省人民医院诊治的高度游离腰椎间盘脱出患者144例,根据随机数字表法将患者分为观察组(采用经对侧椎间孔入路切除技术治疗)与对照组(采用经患侧椎间孔入路切除技术治疗),各72例。收集患者一般资料,记录患者的手术指标、疼痛视觉模拟评分(VAS)、MMP-3表达水平、临床疗效。结果两组患者手术时间、术中X线检查次数比较,差异无统计学意义(P>0.05);观察组患者并发症(马尾神经损伤、椎间隙感染、硬脊膜损伤)发生率低于对照组(P<0.05)。对照组与观察组患者术后3个月VAS均低于本组术前(P<0.05);两组患者术前、术后3个月VAS比较,差异无统计学意义(P>0.05)。观察组与对照组患者术后3个月MMP-3表达水平均低于本组术前(P<0.05);观察组患者术后3个月MMP-3表达水平低于对照组(P<0.05)。观察组的优良率高于对照组(P<0.05)。结论经对侧椎间孔入路切除技术能有效缓解高度游离腰椎间盘脱出患者疼痛,并不增加手术时间与X线检查次数,能有效降低MMP-3表达水平,减少术后并发症的发生,从而提高总体预后疗效。

Objective To investigate the effects of transforaminal lumbar discectomy via contralateral approach on the expression of MMP-3 among patients with sequestered lumbar disc herniation.Methods One hundred and forty-four cases of sequestered lumbar disc herniation managed in Hebei General Hospital from January 2012 to February 2017 were recruited and randomized into the observation group receiving transforaminal lumbar discectomy via contralateral approach and the control group receiving transforaminal lumbar discectomy via ipsilateral approach with 72 in each.We collected their data about baseline characteristics,value of perioperative indices,Visual Analogue Scale（VAS）,MMP-3 expression level,and efficacy evaluation results.Results Two groups demonstrated no obvious differences in the duration of procedure and intraoperative fluoroscopy times（P〈0.05）.The observation group showed lower incidence of complications（cauda equina injury,intervertebral space infection,and dural injury） compared with the control group（P〈0.05）.VAS at baseline was similar in both groups（P〈0.05）,although it was still similar in both groups at 3 months after procedure（P〈0.05）,it showed a significant decrease in both groups（P〈0.05）.At 3 months after procedure,the MMP-3 expression level declined substantially in both groups（P〈0.05）,and it was much lower in the observation group compared with the control group（P〈0.05）.The observation group displayed higher proportion of patients with good to excellent responses to treatment compared to the control group（P〈0.05）.Conclusion For sequestered lumbar disc herniation,transforaminal lumbar discectomy via contralateral approach could improve the outcome by effectively relieving the pain,inhibiting MMP-3 expression level,and reducing the postprocedural incidence of complications without increasing the duration of procedure and intraoperative fluoroscopy times.