摘要
目的 探讨经皮椎间孔镜椎间盘切除术(PTED)治疗腰椎间盘突出症(LDH)后白细胞介素⁃10(IL⁃10)、白细胞介素⁃8(IL⁃8)及P物质(SP)水平的变化及其与神经功能恢复的关系.方法 选取2022年1月至2024年1月保定市第一中心医院收治的131例LDH患者,按照不同治疗术式分为对照组[传统开窗减压髓核摘除术(ODD),n=65)]、试验组(PTED,n=66),比较两组围手术期指标、术前、术后 3 个月腰椎活动功能(腰椎前屈、后伸、左侧屈、右侧屈活动度)、疼痛程度[视觉模拟评分法评分(VAS)]、脊柱功能[腰椎Oswestry功能障碍指数(ODI)]、腰背肌生物力学性能[腰背屈伸比(F/E)、伸展平均功率(AP)、峰力矩(PT)]、实验室指标(IL⁃10、IL⁃8及SP水平)及并发症发生率.结果 试验组手术、住院、下床时间、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).两组术后3个月腰椎前屈、后伸、左侧屈、右侧屈活动度均升高,且试验组高于对照组,差异有统计学意义(P<0.05).两组术后3个月VAS、ODI评分均下降,且试验组低于对照组,差异有统计学意义(P<0.05).两组术后3个月的AP、PT均升高,且试验组高于对照组,两组术后3个月的F/E均降低,且试验组低于对照组,差异有统计学意义(P<0.05).两组术后3 d的IL⁃10、IL⁃8及SP水平均降低,且试验组低于对照组,差异有统计学意义(P<0.05).试验组并发症总发生率(7.57％)明显比对照组并发症总发生率(20.00％)低,差异有统计学意义(P<0.05).Pearson相关性分析显示:PTED治疗腰椎间盘突出症后IL⁃8及SP水平与ODI评分呈正相关关系,IL⁃10水平与ODI评分呈负相关关系(P<0.05).结论 相较于ODD,PTED治疗LDH疗效更佳,可有效促进患者神经功能恢复,降低血清IL⁃10、IL⁃8、SP水平.
Abstract
Objective To investigate the changes of interleukin⁃10(IL⁃10),interleukin⁃8(IL⁃8)and substance P(SP)levels after percutaneous transforaminal endoscopic discectomy(PTED)in the treatment of lumbar disc herniation(LDH)and their relationship with the recovery of neurological function.Methods A total of 131 patients with LDH admitted to Baoding First Central Hospital from January 2022 to January 2024 were selected and divided into a control group[traditional fenestration decompression nucleus pulposus removal(ODD),n=65)]and an experimental group(PTED,n=66)based on different treatment methods.The periop⁃erative indexes,lumbar motion function(lumbar flexion,extension,left flexion and right flexion),pain de⁃gree[visual analogue scale(VAS)],spinal function[lumbar Oswestry dysfunction index(ODI)],biome⁃chanical properties of low back muscle[lumbar dorsiflexion and extension ratio(F/E),average extension power(AP),peak torque(PT)],laboratory indicators(IL⁃10,IL⁃8,and SP levels)and incidence of compli⁃cations were compared between the two groups before and 3 months after operation.Results The experimental group had shorter surgery time,hospitalization time,time out of bed and incision length and less intraoperative bleeding than those of the control group,with statistically significant differences(P<0.05).The lumbar flexion,extension,left flexion and right flexion of the two groups increased at 3 months after operation,and the experi⁃mental group was higher than the control group,the difference was statistically significant(P<0.05).The VAS and ODI scores of the two groups decreased at 3 months after operation,and the experimental group was lower than the control group,the difference was statistically significant(P<0.05).The AP and PT of the two groups in⁃creased at 3 months after operation,and the experimental group was higher than the control group.The F/E of the two groups decreased at 3 months after operation,and the experimental group was lower than the control group.The difference was statistically significant(P<0.05).The levels of IL⁃10,IL⁃8,and SP in the two groups de⁃creased at 3 days after operation,and those in the experimental group were lower than the control group,the dif⁃ferences were statistically significant(P<0.05).The total incidence of complications in the experimental group(7.57％)was significantly lower than that in the control group(20.00％),the difference was statistically signifi⁃cant(P<0.05).Pearson correlation analysis showed that IL⁃8 and SP levels were positively correlated with ODI score after PTED treatment of lumbar disc herniation,and IL⁃10 level was negatively correlated with ODI score(P<0.05).Conclusion Compared to ODD,PTED is more effective in the treatment of LDH,which can effec⁃tively promote the recovery of neurological function,reducing the levels of serum IL⁃10,IL⁃8 and SP.
基金项目
河北省医学科学研究课题计划项目(20220292)
保定市科技计划项目(2441ZF030)
万方数据