经皮椎间孔镜技术对巨大型腰椎间盘突出症患者功能恢复、创伤程度的前瞻性研究

A prospective study of percutaneous transforaminal endoscopy on functional recovery and trauma degree of patients with huge lumbar disc herniation

目的探讨经皮椎间孔镜(PELD)技术对巨大型腰椎间盘突出症(LLDH)患者功能恢复、创伤程度的影响。方法选取2017年6月至2019年7月我院LLDH患者92例进行前瞻性研究,以随机数字表分为观察组(n=46)、对照组(n=46)。对照组行腰椎后路减压椎间植骨融合内固定术(PLIF),观察组应用PELD技术治疗。对比两组手术情况、并发症及术前、术后1、3 d血清创伤程度指标[C反应蛋白(CRP)、白细胞介素-6(IL-6)、β-内啡肽(β-EP)、前列腺素E2(PGE2)]水平、术前、术后1个月、3个月脊髓功能指标(胫神经、腓总神经的潜伏期、神经传导速度),术后随访1年,统计两组疗效与术前、术后6、12个月Oswestry功能障碍指数(ODI)、视觉模拟疼痛评分(VAS)。结果观察组射线暴露量高于对照组,但手术时间、住院时间短于对照组,术中出血量低于对照组(P<0.05);两组并发症发生率相比,差异无统计学意义(P>0.05);观察组术后1 d、3 d时血清CRP、IL-6、β-EP、PGE2水平低于对照组(P<0.05);观察组术后1个月、3个月胫神经、腓总神经的潜伏期低于对照组,神经传导速度高于对照组(P<0.05);观察组术后6个月、1年ODI、VAS评分低于对照组(P<0.05);两组术后1年手术优良率相比,差异无统计学意义(P>0.05)。结论PELD技术治疗LLDH患者可取得与PLIF相当的手术效果,且具有创伤小、手术时间短、术后恢复快等优势,可减轻创伤应激,更有效改善腰腿痛症状及脊髓、腰椎功能,但射线暴露量增加。

Objective To investigate the effect of percutaneous endoscopic lumbar discectomy(PELD)on the functional recovery and trauma of patients with large lumbar disc herniation(LLDH).Methods A total of 92 LLDH patients in our hospital from June 2017 to July 2019 were selected for a prospective study.They were divided into observation group(n=46)and control group(n=46)according to a random number table.The control group underwent posterior lumbar interbody fusion(PLIF),and the observation group was treated with PELD technology.The operation conditions,complications,and serum trauma index[C-reactive protein(CRP),interleukin-6(IL-6),β-endorphin(β-EP),prostaglandin E2(PGE2)]levels before and 1 d and 3 d after the operation,spinal cord function indexes(the incubation period of the tibial nerve and the common peroneal nerve,nerve conduction velocity)before operation,1 month and 3 months after operation were compared between the two groups.The postoperative follow-up was 1 year,and the curative effects and the Oswestry dysfunction index(ODI)and visual analog pain score(VAS)before operation,6 months and 12 months after operation of the two groups were calculated.Results The radiation exposure of the observation group was higher than that of the control group,but the operation time and hospital stay were shorter than those of the control group,and the intraoperative blood loss was lower than that of the control group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05);serum CRP,IL-6,β-EP,and PGE2 levels in the observation group were lower than those in the control group at 1 and 3 days after surgery(P<0.05).The latency of the tibial nerve and common peroneal nerve in the observation group was lower than that of the control group at 1 and 3 months after operation,and the nerve conduction velocity was higher than that of the control group(P<0.05).The ODI and VAS scores of the observation group at 6 months and 1 year after operation were lower than those of the control group(P<0.05);there was no significant difference in the excellent and good rate of operation 1 year after operation in the two groups(P>0.05).Conclusion PELD technology can achieve surgical results equivalent to PLIF in the treatment of LLDH patients,and has the advantages of less trauma,short operation time,and quick postoperative recovery.Moreover,it has the advantages of less trauma,short operation time,and quicker recovery after surgery.It can reduce traumatic stress,and more effectively improve the symptoms of low back pain,spinal cord function,and lumbar function,but the radiation exposure is increased.