经皮椎间孔镜下TESSYS术治疗单节段钙化型腰椎间盘突出症疗效观察

Clinical efficacy of TESSYS under percutaneous foraminiscope in the treatment of single-segment calcified lumbar disc herniation

目的比较经皮椎间孔镜下经椎间孔脊柱内镜系统(TESSYS)和椎板开窗髓核摘除术(FD)治疗单节段钙化型腰椎间盘突出症(LDH)患者的临床疗效。方法回顾性分析2020年1月至2021年12月河南省直第三人民医院收治的105例单节段钙化型LDH患者的临床诊治资料,根据治疗术式不同分为TESSYS术组53例和FD术组52例。比较两组患者围术期指标、炎性反应相关指标[肿瘤坏死因子α(TNF-α)、白细胞介素-10(IL-10)、IL-6]、氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)]、胫总神经、腓总神经的潜伏期(DL)、传导速度(NCV)、腰椎功能评分(ODI)、疼痛程度评分(VAS)和并发症发生情况。结果TESSYS术组患者术中出血量为(38.53±9.61)m L,明显低于FD术组的(219.84±21.50)m L,切口长度为(0.59±0.17)cm,明显小于FD术组的(4.15±1.69)cm,手术用时、术后首次下床时间、住院时间分别为(1.05±0.48)h、(1.74±0.62)d、(6.38±1.47)d,明显短于FD术组的(1.64±0.72)h、(3.49±0.86)d、(10.35±2.03)d,差异均有统计学意义(P<0.05);术后1 d、3 d,两组患者的血清TNF-α、IL-10、IL-6、MDA水平均呈先升高后降低的趋势,而SOD、GSH-Px水平呈现先降低后升高的趋势,但TESSYS术组患者的血清TNF-α、IL-10、IL-6、MDA、SOD、GSH-Px水平波动小于FD术组,差异均有统计学意义(P<0.05);术后1个月、3个月,两组患者的胫总神经和腓总神经的DL呈逐渐降低趋势,NCV呈逐渐升高趋势,且TESSYS术组患者胫总神经和腓总神经的DL、NCV改善程度明显优于FD术组,差异均有统计学意义(P<0.05);术后3个月、6个月、12个月,两组患者的ODI、VAS评分均呈逐渐降低趋势,且TESSYS术组患者的ODI、VAS评分降低幅度明显大于FD术组,差异均有统计学意义(P<0.05);TESSYS术组患者术后并发症发生率为3.77%,明显低于FD术组的17.31%,差异有统计学意义(P<0.05)。结论经皮椎间孔镜下TESSYS术应用于单节段钙化型LDH患者可降低手术创伤,减轻机体的炎性和氧化应激反应,提高神经传导速度,促进脊髓功能及腰椎功能的恢复,减轻疼痛程度,减少并发症的发生。

Objective To compare the clinical efficacy of transforaminal endoscopic spine system(TESSYS)under percutaneous foraminiscope and fenestration discectomy(FD)in the treatment of single-segment calcified lumbar disc herniation(LDH).Methods Clinical diagnosis and treatment data of 105 patients with single-segment calcified LDH admitted to the Third People's Hospital of Henan Province from January 2020 to December 2021 were analyzed retrospectively.They were divided into TESSYS group(n=53)and FD group(n=52)according to different treatment methods.After operation,the perioperative indexes and inflammatory reaction indexes[(tumor necrosis factor-α(TNF-α),interleukin-10(IL-10),IL-6],oxidative stress indexes[malondialdehyde(MDA),superoxide dismutase(SOD),glutathione peroxidase(GSH-Px)],latency(DL),and conduction velocity(NCV)of common tibial nerve and common peroneal nerve,lumbar function score(ODI),pain score(VAS)and complications were compared between the two groups.Results The intraoperative bleeding volume of TESSYS group was(38.53±9.61)mL,which was significantly lower than(219.84±21.50)mL of FD group;the incision length was(0.59±0.17)cm,which was significantly smaller than(4.15±1.69)cm of FD group;the operation time,the first time of getting out of bed after operation,and the length of hospital stay were(1.05±0.48)h,(1.74±0.62)d,(6.38±1.47)d,respectively,which were significantly shorter than(1.64±0.72)h,(3.49±0.86)d,and(10.35±2.03)d in FD group;the differences were statistically significant(P<0.05).After 1 day and 3 days of operation,the serum levels of TNF-α,IL-10,IL-6,and MDA in two groups were firstly increased and then decreased;the levels of SOD and GSH-Px were firstly decreased and then increased;the levels of TNF-α,IL-10,IL-6,MDA,SOD,and GSH-Px in TESSYS group were significantly lower than those in FD group;the differences were statistically significant(P<0.05).After 1 month and 3 months of operation,the DL of the common tibial nerve and common peroneal nerve in the two groups showed a gradually decreasing trend,while the NCV showed a gradually increasing trend,and the improvement degree of DL and NCV of the common tibial nerve and common peroneal nerve in the TESSYS group were significantly better than those in the FD group,with statistically significant differences(P<0.05).After 3 months,6 months,and 12 months of operation,ODI and VAS scores in the two groups showed a gradually decreasing trend,and the reduction ranges of ODI and VAS scores in the TESSYS group were significantly greater than those in the FD group,with statistically significant differences(P<0.05).The incidence of postoperative complications in TESSYS group was 3.77%,which was significantly lower than 17.31%in FD group(P<0.05).Conclusion TESSYS under percutaneous foraminiscope for single-segment calcified LDH patients can reduce the surgical trauma,reduce the inflammatory and oxidative stress reactions of the body,improve the nerve conduction velocity,promote the recovery of spinal cord function and lumbar function,reduce the degree of pain,and reduce the occurrence of complications.