PLDD联合射频热凝术治疗腰椎间盘突出症的疗效及对血清6-keto-PGE1α、PLA2、M-ENK水平的影响

Treatment of PLDD combined with radiofrequency thermocoagulation in patients with lumbar disc herniation and its effect on the levels of 6-keto-PGE1 alpha,PLA2 and M-ENK

目的探讨经皮激光椎间盘减压术(PLDD)联合射频热凝术治疗腰椎间盘突出症患者的效果。方法选取收治的90例腰椎间盘突出症患者进行前瞻性研究,收集时间2016年3月至2017年5月,采用随机数字表法分为联合组45例(PLDD联合射频热凝术治疗)、对照组45例(仅给予射频热凝术治疗)。对比两组患者治疗前1周后、治疗1个月后、治疗3个月视觉模拟评分(VAS);治疗后的临床效果、治疗前后血清6-酮前列腺素E1α(6-keto-PGE1α)、磷脂酶A2(PLA2)、M型脑钠肽(M-ENK)水平。结果治疗前,两组患者的VAS评分差异无统计学意义(P>0.05);在治疗1周后、治疗1个月后、治疗3个月后两组患者的VAS评分较本组治疗前均显著降低(P<0.05),同时联合组的VAS评分均低于同一时间点对照组(P<0.05);联合组治疗后的临床疗效评价优于对照组患者(P<0.05);治疗前,两组患者的血清6-keto-PGE1α、PLA2、M-ENK水平差异无具有统计学意义(P>0.05);治疗后,两组患者的血清6-keto-PGE1α、PLA2水平较本组治疗前均显著的降低(P<0.05),M-ENK较本组治疗前显著升高(P<0.05);治疗后,联合组的血清6-keto-PGE1α、PLA2水平均低于同一时间点对照组(P<0.05),M-ENK高于对照组(P<0.05)。结论 PLDD联合射频热凝术治疗腰椎间盘突出症较单用射频热凝术具有更显著的临床效果,可显著降低血清6-keto-PGE1α、PLA2水平,提高M-ENK水平。

Objective To investigate the effect of percutaneous laser disc decompression （PLDD） combined with radiofrequency thermocoagulation on lumbar disc herniation. Methods 90 cases in our hospital of lumbar disc herniation from March 2016 to May 2017 were enrolled prospectively and randomized into 3 groups, namely combination group （n=45, PLDD combining radiofrequency thermocoagulation） and control （n=45, radiofrequency thermocoagulation alone）. The pretreatment VAS score and that of 1 wk, 1 mo, 3 mo posttreatment were compared for the two groups. Serum 6-keto prostaglandin E1 alpha （6-keto-PGE1 alpha）, phospholipase A2 （PLA2）, M-type natriuretic peptide （M-ENK） were compared for the two groups pre- and posttreatment. Results Before treatment, VAS scores of the two groups showed no significant difference （ P 〉0.05）, and were improved at 1 wk, 1 mo, 3 mo posttreatment respectively （ P 〈0.05）, with the combination group having lower VAS score （ P 〈0.05）. The combination group showed superior clinical remission than control （ P 〈0.05）. Regarding serum 6-keto-PGE1, PLA2, M-ENK levels, the two groups showed no significant differences pretreatment （ P 〉0.05） and saw 6-keto-PGE1 and PLA2 decreased respectively posttreatment （ P 〈0.05） while M-ENK significantly increased respectively posttreatment （ P 〈0.05）, with the combination group having lower 6-keto-PGE1, PLA2 and higher M-ENK than control （ P 〈0.05）. Conclusion PLDD combined with radiofrequency thermocoagulation has superior clinical remission than radiofrequency thermocoagulation alone for the treatment of lumbar disc herniation.