经皮椎间孔镜脊柱系统术对老年LDH合并神经根管狭窄患者腰椎功能及手术效果研究

Study on lumbar vertebrae function and operative effect of transforaminal endoscopic spine system in elderly patients with LDH complicated with nerve root canal stenosis

目的 探讨经皮椎间孔镜脊柱系统(TESSYS)术对老年腰椎间盘突出症(LDH)并神经根管狭窄患者腰椎功能的影响并分析手术效果。方法 前瞻性纳入2020年6月至2023年6月安庆市立医院收治的老年LDH并神经根管狭窄患者66例,按随机抽签法分成TESSYS组与对照组,各33例。对照组行椎板开窗减压加髓核摘除术,TESSYS组行TESSYS术。记录并比较两组手术时间、术中出血量、术后卧床时间、住院时间,术前、术后3 d的血清肿瘤坏死因子-α(TNF-α)、皮质醇、促肾上腺皮质激素(ACTH)水平。比较术前、术后3个月的腰椎曲度、腰骶角角度,运动、感觉神经传导速度,并进行疼痛视觉模拟法(VAS)评分、Oswestry功能障碍指数(ODI)评分,记录并比较术后总体疗效与并发症情况。结果 TESSYS组的手术时间、术中出血量、术后卧床时间、住院时间分别为(76.35±8.21) min、(72.36±6.28) mL、(27.35±2.17) h、(6.31±1.42) d,均短(少)于对照组[(112.49±12.10) min、(133.67±15.69) mL、(30.91±1.06) h、(8.03±1.97) d],差异均有统计学意义(P<0.05)。术后3 d,两组血清TNF-α、皮质醇、ACTH水平较术前增高,且TESSYS组血清TNF-α、皮质醇、ACTH水平分别为(3.15±0.65) ng/mL、(2.69±0.41)μmol/L、(14.21±2.36) pmol/L,均低于对照组[(3.59±0.47) ng/mL、(3.06±0.87)μmol/L、(16.98±3.18) pmol/L],差异均有统计学意义(P<0.05)。术后3个月,两组的腰椎曲度均术前升高,腰骶角角度均较术前降低,且TESSYS组的腰椎曲度为(22.87±4.36) mm,高于对照组[(20.93±3.04) mm],腰骶角角度为(25.39±4.15)°,低于对照组[(27.91±2.90)°],差异均有统计学意义(P<0.05)。术后3个月,两组神经传导速度均较术前升高,且TESSYS组的神经传导速度均高于对照组,差异均有统计学意义(P<0.05)。术后3个月,两组的VAS、ODI评分均较术前降低,且TESSYS组的VAS、ODI评分分别为(2.14±0.51)、(17.50±2.11)分,均低于对照组[(3.10±0.92)、(20.39±3.63)分],差异均有统计学意义(P<0.05)。TESSYS组手术优良率为96.97%,高于对照组(75.76%),差异有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论 TESSYS术能进一步促进老年LDH并神经根管狭窄患者围术期机体功能恢复,减轻炎症与应激反应,改善神经传导速度与腰椎功能,缓解疼痛,提升手术效果。

Objective To investigate the effect of transforaminal endoscopic spine system(TESSYS) on lumbar vertebrae function in elderly patients with lumbar disc herniation(LDH) and nerve root canal stenosis,and to analyze the operative effect.Methods A total of 66 elderly patients with LDH and nerve root canal stenosis admitted to Anqing Municipal Hospital from June 2020 to June 2023 were prospectively included and divided into TESSYS group and control group by random drawing method,33 cases in each group.The control group underwent laminectomy combined with nucleus pulposus extraction,TESSYS group underwent TESSYS operation.The operation time,intraoperative blood loss,postoperative bed time,hospital stay and serum tumor necrosis factor-α(TNF-α),cortisol and adrenocorticotrophin(ACTH) levels before and 3 days after surgery were recorded and compared in the two groups.Lumbar curvature,lumbosacral angle,motor nerve conduction velocity and sensory nerve conduction velocity were compared before and after 3 months surgery.Visual analogue pain scale(VAS) and Oswestry disability Index(ODI) scores were performed and compared,the overall postoperative efficacy and complications were recorded.Results The operation time,intraoperative blood loss,postoperative bed time,hospital stay of the TESSYS group were(76.35±8.21) min,(72.36±6.28) mL,(27.35±2.17) h,and(6.31±1.42) d,respectively,which were shorter(less) than those of the control group [(112.49±12.10) min,(133.67±15.69) mL,(30.91±1.06) h,and(8.03±1.97) d],and the differences were statistically significant(P<0.05).At 3 days after surgery,The levels of serum TNF-α,cortisol and ACTH of two groups were higher than those before surgery,and the levels of serum TNF-α,cortisol and ACTH in the TESSYS group were(3.15±0.65) ng/mL and(2.69±0.41) μmol/L,(14.21±2.36) pmol/L,respectively,which were lower than those in the control group [(3.59±0.47) ng/mL,(3.06±0.87) μmol/L,(16.98±3.18) pmol/L,the differences were statistically significant(P<0.05).At 3 months after surgery,the lumbar curvature of two groups were higher than those before surgery,and the lumbosacral angle were lower than those before surgery,the lumbar curvature of the TESSYS group was(22.87±4.36) mm,which was higher than that of the control group [20.93±3.04) mm],and the lumbosacral angle was(25.39±4.15) °,which was lower than that of the control group [27.91±2.90) °],the differences were statistically significant(P<0.05).At 3 months after surgery,the velocity of motor and sensory nerve conduction of two groups were higher than those before surgery,the velocity of motor and sensory nerve conduction in the TESSYS group were higher than those in the control group,the differences were statistically significant(P<0.05).At 3 months after surgery,the VAS and ODI scores of two groups were lower than those before surgery,the VAS and ODI scores of TESSYS group were(2.14±0.51),(17.50±2.11) points,which were lower than those of the control group [(3.10±0.92),(20.39±3.63) points],the differences were statistically significant(P<0.05).The excellent and good rate of TESSYS group was 96.97%,which was higher than that of control group(75.76%),the difference was statistically significant(P<0.05).There was no statistically significant difference in complication rate between the two groups(P>0.05).Conclusion TESSYS can further promote perioperative functional recovery in elderly patients with LDH and nerve root canal stenosis,reduce inflammation and stress response,improve nerve conduction velocity and lumbar function,relieve pain,and enhance surgical results.