后路显微内镜下椎间盘切除术对腰椎间盘突出症患者症状改善及预后的影响

Effects of Posterior Microendoscopic Discectomy on Symptom Improvement and Prognosis in Patients with Lumbar Disc Herniation

目的探讨后路显微内镜下椎间盘切除术(MED)对腰椎间盘突出症(LDH)患者症状改善及预后的影响。方法选取2016年1月至2018年1月雅安市中医医院收治的71例单节段LDH患者为研究对象,按照干预方法不同分为观察组(n=30)和对照组(n=41),观察组采用MED治疗,对照组采用椎间板开窗髓核摘除术。比较两组围手术期相关指标(手术时间、术中出血量、切口长度、术后3 d最高体温、住院时间),手术前后血清应激指标[白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、术后腰腿疼痛程度[视觉模拟评分(VAS)],恢复生活、工作时间及总体治疗效果。结果观察组患者手术时间、切口长度及住院时间明显短于对照组[(46.6±6.4)min比(76.6±11.7)min、(2.1±0.4)cm比(5.7±1.2)cm、(7.1±1.4)d比(15.0±2.4)d],观察组术中出血量明显少于对照组[(42.4±5.5)mL比(135.2±13.2)mL],观察组术后3 d最高体温明显低于对照组[(36.7±1.1)℃比(37.5±1.2)℃](P<0.01)。血清IL-1β、IL-6及TNF-α水平的组间和时点间存在交互作用(P<0.01),观察组术后6、12、24 h的IL-1β、IL-6及TNF-α水平均显著低于对照组。VAS评分的组间和时点间存在交互作用(P<0.05),观察组术后1、3个月均显著低于对照组。观察组患者术后恢复生活及工作时间均显著短于对照组[(14.2±2.5)d比(19.5±2.4)d、(37.6±5.1)d比(53.1±6.6)d](P<0.01);随访1年,两组患者的临床疗效比较差异无统计学意义(P>0.05)。结论MED具有微创优势,能有效减少术中出血量、降低操作对病变髓核周围组织造成的损伤,提高患者术后恢复速度,缓解临床症状与体征,但手术应建立在严格筛查手术适应证的基础上。

Objective To explore the effects of posterior microendoscopic discectomy(MED)on symptom improvement and prognosis in patients with lumbar disc herniation(LDH).Methods Seventy-one patients with single-segment lumbar disc herniation admitted to Ya′an Hospital of Traditional Chinese Medicine from Jan.2016 to Jan.2018 were included.According to different methods of intervention,they were divided into an observation group(n=30)and a control group(n=41).The observation group was treated with MED,and the control group was treated with fenestration discectomy.The perioperative indicators(operative time,intraoperative blood loss,incision length,maximum body temperature at 3 d after surgery,hospital stay time),serum stress indicators before and after surgery[interleukin-1β(IL-1β),IL-6,tumor necrosis factor-α(TNF-α)],postoperative low back and leg pain[pain visual analogue scale(VAS)],time of life recovery and work recovery,and overall treatment effects were compared between the two groups.Results The operative time,incision length and hospital stay in the observation group were significantly shorter than those in the control group[(46.6±6.4)min vs(76.6±11.7)min,(2.1±0.4)cm vs(5.7±1.2)cm,(7.1±1.4)d vs(15.0±2.4)d],and the intraoperative blood loss was significantly less than that in the control group[(42.4±5.5)mL vs(135.2±13.2)mL],and the highest body temperature at 3 d after surgery was significantly lower than that in the control group[(36.7±1.1)℃vs(37.5±1.2)℃](P<0.01).There were interactions between groups and time points in serum IL-1β,IL-6 and TNF-αlevels(P<0.01),and the IL-1β,IL-6 and TNF-αlevels at 6,12 and 24 h postoperative of the observation group were significantly lower than those of the control group.There was interaction between groups and time points in the VAS score(P<0.05),and the observation group was significantly lower than the control group at 1,3 months after operation.The time of life recovery and work recovery in the observation group after surgery were significantly shorter than those in the control group[(14.2±2.5)d vs(19.5±2.4)d,(37.6±5.1)d vs(53.1±6.6)d](P<0.01).At 1 year of follow-up,there was no significant difference in the treatment effect between the two groups(P>0.05).Conclusion MED has the advantage of minimal invasiveness,and it can effectively reduce the intraoperative blood loss,reduce the damage to the surrounding tissue of nucleus pulposus caused by operation,improve the postoperative recovery rate and relieve clinical symptoms and signs,while the operation should be based on strict screening of surgical indications.