经椎旁肌置入椎弓根螺钉治疗对腰椎退变性侧弯患者氧化应激和关节功能的影响

Pedicle screw placement through paravertebral muscle can improve oxidative stress indexes and joint function in patients with lumbar degenerative scoliosis

目的探究经椎旁肌置入椎弓根螺钉对腰椎退变性侧弯患者氧化应激和关节功能的影响。方法前瞻性选取2021年3月至2022年4月运城市中心医院脊柱外科收治的100例腰椎退变性侧弯患者作为研究对象,按随机数字表法将患者分为对照组(n=50)和研究组(n=50)。其中对照组采用传统正中入路进行螺钉置入术,研究组患者采用经椎旁肌置入椎弓根螺钉术。比较两组患者的手术前、手术后3个月的氧化应激指标[谷胱甘肽过氧化物酶(GSH-Px)、人血管紧张素Ⅱ(Ang-Ⅱ)、去甲肾上腺素(NE)],手术前、手术后1 d、手术后1个月的视觉模拟评分法(VAS)评分、日本骨科协会评估治(JOA)评分,手术前、手术后1 d、手术后3个月的Cobb角、伤锥前缘高度,并观察两组患者的不良反应发生情况。结果手术后3个月,两组患者GSH-Px水平均降低,Ang-Ⅱ、NE水平均升高,但研究组GSH-Px水平为(49.15±2.86)U/L,高于对照组[(31.16±2.96)U/L],Ang-Ⅱ、NE水平分别为(127.14±11.84)mmol/L、(49.25±3.85)ng/mL,均低于对照组[(189.05±14.17)mmol/L、(69.04±4.26)ng/mL],差异均有统计学意义(P<0.05)。手术后1 d、1个月,两组患者VAS评分均降低,JOA评分均升高,且研究组VAS评分分别为(3.73±1.36)、(1.25±0.98)分,低于对照组[(4.32±1.55)、(2.89±1.03)分],JOA评分分别为(13.14±2.01)、(21.98±1.84)分,高于对照组[(12.43±2.16)、(17.98±1.76)分],差异均有统计学意义(P<0.05)。手术后1 d、3个月,两组患者Cobb角均降低,伤锥前缘高度均升高,且研究组Cobb角分别为(13.13±2.04)°、(7.16±1.38)°,低于对照组[(17.28±2.18)°、(11.03±2.04)°],伤锥前缘高度分别为(69.02±6.24)、(88.04±6.02)mm,高于对照组[(65.23±5.83)、(79.98±6.23)mm],差异均有统计学意义(P<0.05)。研究组患者不良反应发生率为5.00%,明显低于对照组(62.00%),差异有统计学意义(P<0.05)。结论与传统正中入路进行螺钉置入术比较,经椎旁肌置入椎弓根螺钉术更能有效调节患者氧化应激指标,降低患者术中术后疼痛感,改善伤锥功能恢复,降低不良反应发生风险,值得临床推广应用。

Objective To investigate the effects of pedicle screw insertion through paravertebral muscle on oxidative stress and joint function in patients with lumbar degenerative scoliosis.Methods In a prospective study,100 patients with lumbar degenerative scoliosis admitted to Department of Spinal Surgery,Yuncheng Central Hospital from March 2021 to April 2022 were selected and divided into control group(n=50)and study group(n=50)according to the random number table method.The control group underwent traditional median approach for screw insertion,and the study group underwent pedicle screw insertion through paravertebral muscle.The oxidative stress indicators[glutathione peroxidase(GSH-Px),human angiotensinⅡ(Ang-Ⅱ),norepinephrine(NE)]before and 3 months after surgery,visual analogue scale(VAS)scores,Japanese Orthopedic Association(JOA)scores before surgery,1 day after surgery,and 1 month after surgery,Cobb angle,and anterior edge height of the injury cone before surgery,1 day after surgery,and 3 month after surgery were compared between the two groups of patients.The occurrence of adverse reactions in two groups was observed.Results At three months after surgery,the GSH-Px levels in two groups decreased,while Ang-Ⅱand NE levels increased,however,the GSH-Px level in the study group was(49.15±2.86)U/L,which was higher than that in the control group[(31.16±2.96)U/L],Ang-Ⅱand NE levels were(127.14±11.84)mmol/L and(49.25±3.85)ng/mL,respectively,which were lower than those in the control group[(189.05±14.17)mmol/L and(69.04±4.26)ng/mL],and the differences were statistically significant(P<0.05).At 1 day and 1 month after surgery,the VAS scores of both groups decreased,while the JOA scores increased,the VAS scores of the study group were(3.73±1.36)and(1.25±0.98)points,respectively,which were lower than those of the control group[(4.32±1.55)and(2.89±1.03)points],the JOA scores were(13.14±2.01)and(21.98±1.84)points,respectively,which were higher than those of the control group[(12.43±2.16)and(17.98±1.76)points],and the differences were statistically significant(P<0.05).At 1 day and 3 months after surgery,the Cobb angle of two groups decreased,and the height of the anterior edge of the injury cone increased,the Cobb angle of the study group were(13.13±2.04)°and(7.16±1.38)°,respectively,which were lower than those of the control group[(17.28±2.18)°and(11.03±2.04)°],the height of the anterior edge of the injury cone were(69.02±6.24)mm and(88.04±6.02)mm,respectively,which were higher than those of the control group[(65.23±5.83)and(79.98±6.23)mm],and the differences were statistically significant(P<0.05).The incidence of adverse reactions in the study group was 5.00%,which was significantly lower than that in the control group(62.00%),and the difference was statistically significant(P<0.05).Conclusion Compared with pedicle screw insertion through paravertebral muscle,traditional screw insertion through median approach is more effective in regulating oxidative stress indexes,reducing intraoperative and postoperative pain,improving cone function recovery,and not increasing the risk of adverse reactions,which is worthy of clinical application.