经皮椎间孔镜腰椎间盘切除术与微创经间孔入路腰椎融合术对单节段腰椎间盘突出症患者疼痛程度及腰椎功能的影响

Effects of percutaneous transforaminal endoscopic lumbar discectomy and minimally invasive transforaminal lumbar fusion on pain degree and lumbar function in patients with single-level lumbar disc herniation

目的探究经皮椎间孔镜腰椎间盘切除术(percutaneous transforaminal endoscopic lumbar discectomy,PELD)与微创经间孔入路腰椎融合术(minimally invasive transforaminal lumbar fusion,MIS-TLIF)对单节段腰椎间盘突出症(lumbar disc herniation,LDH)患者疼痛程度及腰椎功能的影响。方法选取2021年3月至2022年8月抚州市第一人民医院收治的72例单节段LDH患者作为研究对象,随机分为对照组与观察组,每组36例。对照组行MIS-TLIF治疗,观察组行PELD治疗。比较两组手术指标、疼痛程度、腰椎功能、生命质量、炎症水平及不良反应发生情况。结果观察组手术时间、术后住院时间、切口长度短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05)。治疗后,两组简明McGill疼痛问卷(short-form of McGill Pain Questionnaire,SF-MPQ)评分均低于治疗前,两组旋转活动度、屈伸活动度及对照组侧屈活动度均大于治疗前,且观察组SF-MPQ评分及腰椎旋转活动度、侧屈活动度、屈伸活动度评分均小于对照组,差异有统计学意义(P<0.05)。治疗后,观察组生理功能、躯体角色、机体疼痛、一般健康、精力、社会功能、情感角色、心理健康评分高于对照组,差异有统计学意义(P<0.05)。治疗后,观察组血清白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平高于对照组,差异有统计学意义(P<0.05)。两组并发症总发生率比较差异无统计学意义。结论治疗单节段LDH患者时,PELD与MIS-TLIF术后均不会出现过多并发症,但PELD术患者手术指标、术后恢复效果均比MIS-TLIF术更佳,能有效改善LDH患者预后。

Objective To study the effects of percutaneous transforaminal endoscopic lumbar discectomy(PELD)and minimally invasive trans-foraminal lumbar fusion(MIS-TLIF)on pain degree and lumbar function in patients with single-level lumbar disc herniation(LDH).Methods 72 patients with single-level lumbar disc herniation received in First People's Hospital of Fuzhou from March 2021 to August 2022 were selected as the study subjects,and they were randomly divided into the control group and the observation,with 36 cases in each group.The control group was treated with MIS-TLIF,and the observation group was treated with PELD.The surgical indexes,pain degree,lumbar function,quality of life,inflam-mation level and the occurrence of adverse reactions were compared between the two groups.Results The operation time,postoperative hospital-ization time and incision length in the observation group were shorter than those in the control group,and the intraoperative blood loss was less than that in the control group,the differences were statistically significant(P<0.05).After treatment,the scores of the short-form McGill Pain Question-naire(SF-MPQ)of the two groups were lower than before treatment,and the rotational motion,flexion and extension motion of the two groups and the lateral flexion motion inthe control group were greater than before treatment,and the SF-MPQ scores and lumbar rotational motion,lateral flex-ion and extension motion scores in the observation group were lower than those in the control group,but the SF-MPQ scores,lumbar rotational mo-tion,lateral flexion motion,flexion and extension motion scores in the observation group were lower than those in the control group,and the differ-ences were statistically significant(P<0.05).After treatment,the scores of physiological function,physical role,body pain,general health,energy,social function,emotional role and mental health scores in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).After treatment,the serum levels of interleukin-6(IL-6)and tumor necrosis factorα(TNF-α)in the observa-tion group were higher than those in the control group,and the differences were statistically significant(P<0.05).There was no significant differ-ence in the total incidence of complications between the two groups.Conclusion In the treatment of single-segment lumbar disc herniation,there will not be too many complications after PELD and MIS-TLIF,but the surgical index and postoperative recovery effect of PELD patients are superior to that of MIS-TLIF,which can effectively improve the prognosis of LDH patients.