脊柱微创髓核摘除术对腰椎间盘突出症患者血清TXB2、PGE2、IL-6水平及腰椎功能的影响

Effect of spinal minimally invasive nucleus pulpectomy on the levels of serum TXB2, PGE2, IL-6 and lumbar spine function in patients with lumbar disc herniation

目的探究脊柱微创髓核摘除术对腰椎间盘突出症患者血清血栓素B2(TXB2)、前列腺素E2(PGE2)、白细胞介素-6(IL-6)水平及腰椎功能的影响。方法回顾性分析2017年5月至2019年5月张家口市第二医院收治的80例腰椎间盘突出症患者,按手术方法的不同分为椎板开窗髓核摘除术组和经皮椎间孔镜下髓核摘除术组,各40例,随访并比较两组患者手术相关指标:术前、术后3 d的血清TXB2、PGE2、IL-6、TNF-α水平,以及术前、术后3个月的VAS、ODI、JOA评分,统计两组并发症发生情况。结果 80例患者获得随访,随访时间为3~6个月。经皮椎间孔镜下髓核摘除术组切口长度(0.7±0.3)cm、手术时间(73±22)min、卧床时间(1.2±0.4)d均短于椎板开窗髓核摘除术组[(3.8±1.7)cm;(106±28)min;(2.2±0.4)d,t=11.230;5.840;8.771,P<0.05],术中出血量(44±15)mL少于椎板开窗髓核摘除术组[(98±34)mL,t=9.190,P<0.05)];与术前相比,术后3 d,两组血清TXB2、PGE2、IL-6、肿瘤坏死因子-α(TNF-α)水平均降低(P<0.05),且经皮椎间孔镜下髓核摘除术组低于椎板开窗髓核摘除术组(t=6.271;4.925;4.963;24.947,P<0.05);与术前相比,术后3个月,两组VAS、ODI评分均降低(P<0.05),且经皮椎间孔镜下髓核摘除术组低于椎板开窗髓核摘除术组(P<0.05);两组JOA评分均显著升高(t=8.661,P<0.05),且经皮椎间孔镜下髓核摘除术组高于椎板开窗髓核摘除术组(P<0.05);经皮椎间孔镜下髓核摘除术组并发症总发生率为5.00%,显著低于椎板开窗髓核摘除术组的25.00%(χ^2=4.800,P<0.05)。结论经皮椎间孔镜下髓核摘除术作为一种脊柱微创手术,可降低腰椎间盘突出症患者血清TXB2、PGE2、IL-6水平,缓解患者腰痛症状,有利于患者腰椎功能的恢复,值得推广应用。

Objective To investigate the effects of spinal minimally invasive nucleus pulpectomy on the levels of serumthromboxane B2(TXB2),prostaglandin E2(PGE2),interleukin-6(IL-6) and lumbar spine function in patients with lumbar disc herniation.Methods Retrospective analysis of 80 patients with lumbar disc herniation admitted to the hospital between May 2017 and May 2019,according to the different surgical methods,they were divided into the laminectomy group and the perforating nucleus pulposynthesis group,with 40 cases in each group,the two groups were followed up for 3 months.The surgical related indicators between the two groups of patients were conmpared;the levels of serum TXB2,PGE2,IL-6,TNF-α and complications before and after 3 days of surgery were compared;The scores of VAS,ODI,and JOA in the two groups of patients before and 3 months after the operation were compared.Results Eighty patients were followed up for 3-6 months.The incision length(0.7±0.3) cm,the operation time(73±22) min,and the bed rest time(1.2±0.4) d in the perforated intervertebral nucleus pulposus removal group were shorter than the laminectomy nucleus pulposus removal group [(3.8±1.7) cm,(106±28) min,(1.2±0.4) d,t=11.230,5.840,8.771,P<0.05)],intraoperative blood loss(44 ± 15) mL was less than the lamina nucleus pulposus enucleation group [(98 ± 34)mL,P<0.05)].Compared with before surgery,the levels of serum TXB2,PGE2,IL-6,and TNF-ain the two groups were significantly reduced after 3 days of surgery(P<0.05),and the perforating nucleus pulposynthesis group was lower than the laminectomy group(t=6.271;4.925;4.963;24.947,P<0.05);Compared with before surgery,the scores of VAS and ODI in the two groups were significantly reduced after 3 months of surgery(P<0.05),and the perforating nucleus pulpo synthesis group was lower than the laminectomy group(P<0.05);Compared with before surgery,the score of JOA in the two groups increased significantly after 3 months of surgery(P<0.05),and the perforating nucleus pulpo synthesis group was higher than the laminectomy group(P<0.05);The total incidence of complications in the perforating nucleus pulpo synthesis group 5.00% was significantly lower than that in the laminectomy group 25.00%(χ^2=4.800,P<0.05).Conclusion Percutaneous foraminal nucleus enucleation as a spinal minimally invasive surgery can reduce the levels of serum TXB2,PGE2,and IL-6 in patients with lumbar disc herniation,alleviate back pain symptoms,and help patients with lumbar spine function recovery.It is worthwhile Promotion and application.