经皮椎间孔镜下微创治疗成人腰椎间盘突出症效果观察及其对髓核基质金属蛋白酶-1的影响

Effect of minimally invasive percutaneous transforaminal endoscopic discecomy on lumbar disc herniation in adults and its effect on matrix metalloproteinase-1

目的探讨经皮椎间孔镜下微创治疗成人腰椎间盘突出症的效果及其对患者髓核基质金属蛋白酶-1(matrix metalloproteinase-1,MMP-1)的影响。方法选取本院2014年7月至2016年7月收治的腰椎间盘突出症成人患者102例为研究对象,按照随机数表法将入选患者分为观察组与对照组,每组各51例。对照组患者采用传统椎板开窗术治疗,观察组患者采用经皮椎间孔镜下微创治疗。比较两组患者的手术时间、术中出血量、术前、术后7天、术后1个月及术后6个月视觉模拟评分法(visual analogue scale,VAS)评分及髓核MMP-1的表达水平。结果观察组患者手术时间明显短于对照组(P<0.05),术中出血量明显少于对照组(P<0.05)。两组患者术前VAS评分比较无显著差异(P>0.05);术后7天、术后1个月及术后6个月,两组患者VAS评分均显著低于本组术前(P<0.05),观察组患者术后不同时间点VAS评分均显著低于同期对照组(P<0.05)。观察组患者髓核中MMP-1的表达水平显著低于对照组(t=36.478,P<0.05)。结论经皮椎间孔镜下微创治疗成人腰椎间盘突出症,效果明显,可缩短手术时间,减少术中出血量,降低髓核中MMP-1的表达水平,具有重要的研究价值。

Objective To discuss the effect of percutaneous transforaminal endoscopic discecomy in the treatment of lumbar disc herniation in adults and its effect on matrix metalloproteinase-1(MMP-1).Method102adult patients with lumbar disc herniation in our hospital from July2014to July2016were selected as objects of study,they were randomly were divided into observation group and control group,51cases ineach group.Patients in control group were treated with conventional laminectomy,and patients in observation group were treated with minimally invasive percutaneous transforaminal endoscopic treatment.The time of operation,the amount of bleeding during the operation,the VAS score at before operation,7days,1month and6months after operation and the expression level of MMP-1in nucleus pulposus of the two groups were compared.Result The operation time of observation group was shorter than that of control group(P<0.05),and the amount of bleeding during operation was less than that of control group(P<0.05).VAS scores of the two groups showed no significant difference before operation(P>0.05);7days,1month and6months after operation,VAS scores of the two groups were significantly lower than of before operation(P<0.05);at different time points after operation,VAS scores of observation group were significantly lower than those of control group(P<0.05).MMP-1expression level in nucleus pulposus of observation group was significantly lower than that of control group(t=36.478,P<0.05).Conclusion Minimally invasive percutaneous transforaminal endoscopic in the treatment of adult lumbar disc herniation has obviously effect,which can shorten the operation time,reduce the amount of bleeding during operation and reduce the expression of MMP-1in nucleus pulposus,it has important research value.