经皮椎间孔镜与开放椎板间开窗术对腰椎间盘突出症患者机体应激及治疗效果的影响

Effects of Percutaneous Foraminoscopy and Open Fenestration on Stress and Therapeutic Effect of Patients with Lumbar Disc Herniation

目的:探讨经皮椎间孔镜与开放椎板间开窗术对腰椎间盘突出症患者机体应激及治疗效果的影响.方法:选取2021年3月—2023年3月我院收治的80例腰椎间盘突出症患者为研究对象,按随机数字表法将其分为对照组与研究组,各40例.2组患者分别行开放椎板间开窗术与经皮椎间孔镜手术治疗,对2组患者不同术式机体应激相关指标及治疗效果予以评价,并对比手术前后CT表现.结果:术后24 h,2组患者血清中PGE2、NGF、NPY、β-EP水平均较术前升高,但研究组PGE2、NGF、NPY水平均低于对照组,β-EP水平高于对照组,差异有统计学意义(P<0.05);2组IL-1β、TNF-α、MMP-3、Hs-CRP、SOD、MDA、NE水平均较术前升高,但研究组低于对照组,差异有统计学意义(P<0.05).研究组治疗优良率高于对照组,差异有统计学意义(P<0.05);研究组术中出血量少于对照组,并发症发生率低于对照组,切口长度、卧床及住院所需时间均短于对照组,手术时间长于对照组,组间差异有统计学意义(P<0.05);2组患者术后CT显示患椎生理解剖结构均较术前明显改善.结论:与开放椎板间开窗术相比,经皮椎间孔镜手术创伤、患者的机体应激反应及术后疼痛较轻,并发症少,患者恢复快,治疗效果显著,对促进腰椎间盘突出症患者尽快步入正常生活及工作具有积极意义.

Objective:To investigate the effects of percutaneous transforaminal endoscopic discectomy and open interlaminar fenestration on body stress and treatment effect in patients with lumbar disc herniation.Methods:80 patients with lumbar disc herniation admitted to our hospital from March 2021 to March 2023 were selected as the research objects.According to the random number table method,they were divided into a control group and a study group,with 40 cases in each group.The two groups of patients were treated with open interlaminar fenestration and percutaneous transforaminal endoscopic discectomy,respectively.The stress-related indexes and therapeutic effects of the two groups of patients were evaluated,and the CT manifestations before and after operation were compared.Results:24 h after operation,the serum levels of PGE2,NGF,NPY andβ-EP in the two groups were higher than those before operation,but the levels of PGE2,NGF and NPY in the study group were lower than those in the control group,and the level ofβ-EP was higher than that in the control group,the difference was statistially significant(P<0.05).The levels of IL-1β,TNF-α,MMP-3,Hs-CRP,SOD,MDA,and NE in the two groups were higher than those before operation,but those in the study group were lower than those in the control group,the difference was statistially significant(P<0.05).The excellent and good rate of treatment in the study group was higher than that in the control group,and the difference was statistically significant(P<0.05).The intraoperative blood loss of the study group was less than that of the control group,the incidence of complications was lower than that of the control group,the incision length,bed rest and hospitalization time were shorter than those of the control group,and the operation time was longer than that of the control group,the differences between the two groups were statistically significant(P<0.05).Postoperative CT showed that the physiological and anatomical structures of the affected vertebrae were significantly improved in both groups.Conclusion:Compared with open interlaminar fenestration,percutaneous transforaminal endoscopic discectomy has less trauma,stress response and postoperative pain,fewer complications,faster recovery of patients,and significant therapeutic effect.It has positive significance for promoting patients with lumbar disc herniation to return to normal life and work as soon as possible.