侧路椎间孔镜髓核摘除术对LDH患者血清PGE2、sTNF-RI水平的影响

Effect of lateral foraminal nucleus pulposus excision on serum PGE2 and STNF-RI levels in patients with LDH

目的探讨侧路椎间孔镜髓核摘除术(PTED)对腰椎间盘突出症(LDH)患者术后血清前列腺素E2(PGE2)、可溶性肿瘤坏死因子I型受体(sTNF-RI)及炎性细胞因子水平变化的影响。方法选取2016年1月至2021年3月连云港市中医院收治的85例LDH患者为研究对象,根据患者个人意愿分为对照组(n=40)和观察组(n=45),对照组给予后路椎板间开窗髓核摘除术(FD)治疗,观察组给予PTED治疗,比较两组围术期指标(手术时间、术中出血量、术后下床时间、住院时间)、疼痛程度(VAS)评分、腰椎Oswestry功能障碍指数(ODI)、血清PGE2、sTNF-RI水平及炎性细胞因子[白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)]水平和并发症发生率。结果观察组手术时间、术后下床时间及住院时间短于对照组,术中出血量少于对照组,差异均有统计学意义(P<0.05)。术后两组VAS、ODI评分和血清PGE2、IL-6、IL-1β、TNF-α水平均降低,sTNF-RI水平升高(P<0.05);且观察组VAS、ODI评分和血清PGE2、IL-6、IL-1β、TNF-α水平低于对照组,sTNF-RI水平高于对照组,差异均有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论 PTED治疗LDH疗效显著,可改善术后疼痛和功能障碍,降低血清PGE2水平和炎性细胞因子水平,提高血清sTNF-RI水平,安全性较高。

Objective To explore the effect of percutaneous transforaminal endoscopic discectomy(PTED)on serum prostaglandin E2(PGE2),soluble tumor necrosis factor type-I receptor(sTNFRI)and inflammatory cytokines in patients with lumbar disc herniation(LDH). Methods A total of 85 patients with LDH admitted to the hospital were selected as the research subjects from January 2016 to March2021. According to the patients. willingness,they were divided into the control group(n=40) and the observation group(n=45). The control group was treated with fenestration discectomy(FD),while the observation group was treated with PTED. The perioperative indexes(operation time,intraoperative blood loss,postoperative ambulation time,hospitalization time),scores of Visual Analogue Scale(VAS),lumbar Oswestry dysfunction index(ODI),levels of serum PGE2,sTNF-RI and inflammatory cytokines[interleukin-6(IL-6),interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α)],and incidence of complications between the two groups were compared. Results The operative time,postoperative ambulation time and hospital stay in the observation group were shorter than those in the control group,and the amount of intraoperative blood loss in the observation group was less than that in the control group,the differences were statistically significant(P<0.05). After surgery,VAS and ODI scores,serum PGE2,IL-6,IL-1β and TNF-α levels were decreased,while s TNF-RI level was increased in both groups(P<0.05). After surgery,VAS and ODI scores,serum PGE2,IL-6,IL-1β and TNF-α levels in the observation group were lower than those in the control group,while s TNF-RI level was higher than that in the control group,the differences were statistically significant(P<0.05). The incidence of complications in the observation group was lower than that in the control group(5.36%vs 19.64%),the differences were statistically significant(P<0.05). Conclusion PTED has a significant curative effect in the treatment of LDH,which can improve postoperative pain and dysfunction,reduce level of serum PGE2 and inflammatory cytokines,and increase level of serum s TNF-RI with high safety.