经皮椎间孔镜髓核摘除术治疗腰椎间盘突出症的疗效及对腰背肌生物力学性能、疼痛介质的影响

Therapeutic effect of lumbar disc herniation by percutaneous transforaminal endoscopic discectomy and its effect on lumbodorsal muscle biomechanical properties and pain mediators

目的研究经皮椎间孔镜髓核摘除术(PTED)治疗腰椎间盘突出症(LDH)的疗效及对腰背肌生物力学性能、疼痛介质的影响。方法前瞻性选择2020年7月至2023年6月于保定市第一中心医院接受治疗的LDH患者110例,按照随机数字表法分为PTED组(n=55)、对照组(n=55)。对照组行开窗减压髓核摘除术(ODD)治疗,PTED组行PTED治疗。观察两组手术时间、切口长度、术中出血量、下床时间、住院时间等围手术期指标;比较两组术前、术后3个月腰椎活动功能指标(腰椎前屈、侧屈、后伸)、脊柱功能[Oswestry功能障碍指数(ODI)]、腰背肌生物力学性能指标[腰背屈伸比(F/E)、伸展平均功率(AP)、峰力矩(PT)]、血清疼痛介质[去甲肾上腺素(NE)、P物质、五羟色胺]水平及术后并发症发生情况。结果PTED组手术时间、切口长度、术中出血量、下床时间、住院时间分别为(72.36±7.51)min、(0.82±0.09)cm、(40.06±4.24)mL、(1.32±0.15)d、(4.30±0.46)d,均短于对照组[(102.64±12.67)min、(5.23±0.55)cm、(96.09±9.84)mL、(3.79±0.39)d、(4.94±0.52)d],差异均有统计学意义(P<0.05)。术后3个月,PTED组腰椎前屈、左侧屈、右侧屈、后伸度数及PT分别为(84.65±8.73)°、(24.83±2.70)°、(25.63±2.82)°、(25.89±2.78)°、(84.67±8.72)Nm,均高于对照组[(78.94±8.01)°、(21.38±2.25)°、(22.85±2.40)°、(21.97±2.44)°、(78.85±8.21)Nm],PTED组的ODI评分、F/E、AP分别为(27.65±3.01)分、(70.48±7.34)%、(40.37±4.31)W,均低于对照组[(32.84±3.46)分、(75.26±7.80)%、(35.72±3.73)W],差异均有统计学意义(P<0.05)。PTED组血清NE、P物质、五羟色胺水平分别为(1.32±0.14)pg/mL、(52.08±5.43)ng/mL、(0.18±0.02)μmol/mL,均低于对照组[(1.68±0.19)pg/mL、(69.94±7.27)ng/mL、(0.22±0.03)μmol/mL],差异均有统计学意义(P<0.05)。PTED组术后总并发症发生率为1.82%,小于对照组(12.73%),差异有统计学意义(P<0.05)。结论PTED治疗LDH可减小手术创伤及术后并发症发生率,增强腰椎活动功能、脊柱功能,改善患者腰背肌生物力学性能,降低血清疼痛介质水平,有助于患者康复。

Objective To study the therapeutic effect of treatment of lumbar disc herniation(LDH)by percutaneous transforaminal endoscopic discectomy(PTED)and its effect on lumbodorsal muscle biomechanical properties and pain mediators.Methods A total of 110 LDH patients treated in Baoding First Central Hospital from July 2020 to June 2023 were prospectively selected and divided into PTED group(n=55)and control group(n=55)according to the random number table method.The control group was treated with open decompression discectomy(ODD),and the PTED group was treated with PTED.Perioperative indexes such as operation time,incision length,intraoperative blood loss,length of getting out of bed and hospital stay in two groups were observed.The lumbar movement function indexes(lumbar anterior flexion,lateral flexion and posterior extension),spinal function[Oswestry disability index(ODI)],lumbodorsal muscle biomechanical properties[flexor/extensor(F/E),average power(AP),peak torque(PT)],serum pain mediators[norepinephrine(NE),substance P and serotonin]before surgery and 3 months after surgery,the occurrence of postoperative complications in two groups were compared.Results The operation time,incision length,intraoperative blood loss,length of getting out of bed and hospital stay in PTED group were(72.36±7.51)min,(0.82±0.09)cm,(40.06±4.24)mL,(1.32±0.15)d,(4.30±0.46)d,respectively,which were shorter than those in control group[(102.64±12.67)min,(5.23±0.55)cm,(96.09±9.84)mL,(3.79±0.39)d,(4.94±0.52)d],the differences were statistically significant(P<0.05).Three mouths after the surgery,lumbar anterior flexion,left flexion,right flexion,posterior extension and PT in PTED group were(84.65±8.73)°,(24.83±2.70)°,(25.63±2.82)°,(25.89±2.78)°,(84.67±8.72)Nm,respectively,which were higher than those in control group[(78.94±8.01)°,(21.38±2.25)°,(22.85±2.40)°,(21.97±2.44)°,(78.85±8.21)Nm],the ODI score,F/E,AP were(27.65±3.01)points,(70.48±7.34)%,(40.37±4.31)W,respectively,which were lower than those of the control group[(32.84±3.46)points,(75.26±7.80)%,(35.72±3.73)W],the differences were statistically significant(P<0.05).The levels of serum(NE),substance P and serotonin in PTED group were(1.32±0.14)pg/mL,(52.08±5.43)ng/mL,(0.18±0.02)μmol/mL,respectively,which were lower than those in control group[(1.68±0.19)pg/mL,(69.94±7.27)ng/mL,(0.22±0.03)μmol/mL],the differences were statistically significant(P<0.05).The incidence of postoperative complications in PTED group was 1.82%,which was lower than that in control group(12.73%),the difference was statistically significant(P<0.05).Conclusion PTED treatment of LDH can reduce surgical trauma and postoperative complications,enhance lumbar movement function and spinal function,improve the lumbodorsal muscle biomechanical properties,reduce the level of serum pain mediators,and contribute to the rehabilitation of patients.