经皮椎间孔镜治疗腰椎间盘突出症的疗效及对炎症因子的干预作用、疗效影响因素分析

The effect of percutaneous foraminoscopy on lumbar disc herniation and its intervention on inflammatory factors and factors influencing the effect

目的分析经皮椎间孔镜治疗腰椎间盘突出症的疗效及对炎症因子的干预作用、疗效影响因素。方法选择125例接受经皮椎间孔镜治疗的腰椎间盘突出症患者,术后随访3个月;在术后1 d、7 d、1个月及3个月进行疼痛和功能评分,在院内(术前1 d及术后7 d)检测血清疼痛介质和炎症因子水平。结果所有患者均获得随访,术后1d、7d、1个月及3个月的腰痛VAS评分、腿痛VAS评分及ODI评分均低于术前,差异均有统计学意义(P<0.05);患者术后7 d的血清去甲肾上腺素(NE)、多巴胺(DA)、5-羟色胺(5-HT)及P物质(SP)水平均低于术前,差异均有统计学意义(P<0.05);患者术后7 d的血清白细胞介素-4(IL-4)、白细胞介素-10(IL-10)均高于术前,白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)均低于术前,差异均有统计学意义(P<0.05);经单因素分析,年龄、病程、临床症状、椎间盘退变程度均与腰椎间盘突出症患者经皮椎间孔镜治疗后疗效密切相关(P<0.05);经多因素Logistic回归分析,年龄≥45岁、病程>12个月、腰腿痛兼重、腰椎间盘退变PfirrmannⅣ级均是疗效不佳的独立预测因素(P<0.05)。结论经皮椎间孔镜治疗腰椎间盘突出症具有较好的疗效,可改善炎症因子水平,但疗效受年龄、病程、腰腿痛症状、腰椎间盘退变Pfirrmann分级影响。

Objective To analyze the efficacy of percutaneous foraminoscopy in the treatment of lumbar disc herniation,the intervention effect on inflammatory factors and the influencing factors of the efficacy.Methods 125 patients with lumbar disc herniation who received percutaneous foraminal endoscopic treatment were selected and postoperative follow-up was 3 months.The pain score and function score were measured at 1 day,7 days,1 month and 3 months after operation.Serum pain mediators and inflammatory factors were detected in hospital(1 day before surgery and 7 days after operation).Results All patients were followed up,the postoperative 1 day,7 days,1 month and 3 months of lumbar pain VAS score,leg pain VAS score and ODI score were lower than those before operation,and the differences were statistically significant(P<0.05).At 7 days after operation,serum levels of norepinephrine(NE),dopamine(DA),5-hydroxytryptamine(5-HT)and substance P(SP)were lower than those before operation,and the differences were statistically significant(P<0.05).At 7 days after operation,serum interleukin-4(IL-4)and interleukin-10(IL-10)were higher than those before operation,while serum interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were lower than those before operation,the differences were statistically significant(P<0.05).According to univariate analysis,age,course of disease,clinical symptoms and degree of intervertebral disc degeneration were closely correlated with the therapeutic effect of percutaneous foraminoscopy(P<0.05).Multivariate Logistic regression analysis showed that age≥45 years old,course of disease>12 months,lumbar and leg pain,lumbar disc degeneration Pfirrmann gradeⅣwere independent predictors of poor efficacy(P<0.05).Conclusion Percutaneous foraminoscopy is effective in the treatment of lumbar disc herniation and can improve the level of inflammatory factors,but the efficacy is affected by age,course of disease,symptoms of lumbar and leg pain,and Pfirrmann grade of lumbar disc degeneration.