双极射频椎间盘髓核成形术对颈椎间盘突出症患者血清IL-1β TNF-α及TXB2水平的影响

Curative Efficacy of Bipolar Radiofrequency Discectomy in Treatment of Cervical Intervertebral Disc Protrusion and Effects on Serum IL-1β TNF-α and TXB2 Levels

目的:探讨双极射频椎间盘髓核成形术对颈椎间盘突出症的治临床疗效及对患者血清白介素(IL-1β)、肿瘤坏死因子(TNF-α)、血栓素(TXB2)水平的影响。方法:回顾性分析2014年12月至2016年12月我院行射频椎间盘髓核成形术的96例颈椎间盘突出症患者临床资料,48例行单级射频的作为单级组,48例行双极射频的患者作为双极组。单级组将射频针工作端置入突出物基底部,双级组则将突出物基底夹在两针工作端之间,两电极针尖端指尖距离需<0.8cm。比较两组手术前后视觉模拟评分法(VAS)、血清IL-1β、TNF-α、TXB2水平以及颈椎JOA评分的变化、临床疗效及术后并发症的发生情况。结果:手术后第7天、第14天,两组VAS评分及血清IL-1β、TNF-α、TXB2水平较手术前均明显降低(P<0.05),且双极组以上指标均明显低于单级组(P<0.05);手术后第14天、第30天,两组JOA评分较治疗前均明显增加(P<0.05),双极组以上指标均明显高于单级组(P<0.05);双极组术后临床优良率明显高于单级组(P<0.05) ;两组术后并发症的发生率比较差异无统计学意义(P>0.05)。结论:双极射频椎间盘髓核成型术治疗颈椎间盘突出症患者的临床效果显著,有助于缓解术后疼痛,改善颈椎功能,其内在机制可能与降低血清IL-1β、TNF-α、TXB2水平相关。

Objective： To investigate the effect of bipolar radiofrequency disc nucleoplasty on the clinical efficacy of cervical disc herniation and the effects on serum levels of interleukins（ IL-1 beta）,tumor necrosis factor（ TNF-alpha） and thromboxane（ TXB2） in patients. Methods： The clinical data of 96 cases of cervical disc herniation in our hospital from Dec. 2014 to Dec. 2016 were retrospectively analyzed. 48 cases of single stage radiofrequency were used as a single stage group and 48 patients with bipolar radiofrequency were used as a bipolar group. The monopole group was protrused RF needle at the base of the protrusion,while the bipolar group was protrused base is sandwiched between the two needle operating ends,the distance between two electrodes and tips should less than 0.8 cm. The visual analogue scale（ VAS）,serum IL-1β,TNF-α,TXB2 and JOA scores before and after the operation,clinical efficacy and incidence of postoperative complications were compared between two groups. Results： On the 7 th,14 th day after operation,the VAS score and serum IL-1β,TNF-α and TXB2 levels of both groups were significantly lower than those before operation（ P〈0.05）,and the VAS score,serum IL-1β,TNF-α and TXB2 levels of bipolar group were significantly lower than those of the monopole group on the 7 th,14 th day after operation（ P〈0.05）; On the 14 th,30 th day after operation,the JOA scores of both groups were significantly increased compared with those before treatment（ P〈0. 05）,and the JOA scores of bipolar group were significantly lower than those of the monopole group on the14 th,30 th day after operation（ P〈0.05）; the excellent and good rate of bipolar group was significantly higher than that of the monopole group（ P〈0.05）; there was no significant difference in the incidence of postoperative complications between the two groups（ P〈0. 05）. Conclusion： Bipolar radiofrequency discectomy is prominently effective for cervical intervertebral disc protrusion,which can relieve the postoperative pain and improve the function of cervical spine,its intrinsic mechanism may be related to the decrease of serum IL-1β,TNF-α,TXB2 expression.