经皮椎间孔镜治疗老年腰椎间盘突出症的效果分析  

Clinical effect of percutaneous endoscopic lumbar discectomy treatment for elderly patients with lumbar disc herniation

作　　者：王平[1] 刘莅彤[1] 王昊[1] 武春雷[1] 张红[1] WANG Ping LIU Li-tong WANG Hao WU Chun-lei ZHANG Hong(Department of Orthopedics, the 254th Hospitals of People＇s Liberation Army, Tianjin 300142, China)

机构地区：[1]中国人民解放军第二五四医院骨科,天津300142

出　　处：《中国医学前沿杂志（电子版）》2016年第11期80-83,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探讨经皮椎间孔镜对老年腰椎间盘突出症患者的疗效和对基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)表达的影响。方法将2013年12月至2015年10月本院收治的116例老年腰椎间盘突出症患者随机分为研究组和对照组,每组各58例。对照组患者行显微镜下腰椎间盘切除术治疗,研究组患者行经皮椎间孔镜下腰椎间盘切除术治疗。并采用蛋白质印迹法分别检测两组患者术中摘除的髓核组织中MMP-9和组织金属蛋白酶抑制物-1(tissue inhibitor of metalloproteinase-1,TIMP-1)表达水平。随访6个月,比较两组患者的手术时间、切口长度、术中透视时间、住院时间、术后参加工作时间、手术前后视觉模拟评分法(visual analogue scale,VAS)评分、Oswestry功能障碍指数及术后椎间盘Pfirrmann分级的差异。结果研究组患者手术时间和术中透视时间均长于对照组(P<0.05),切口长度、住院时间、术后参加工作时间均短于对照组(P<0.05)。两组患者术前Oswestry功能障碍指数和VAS评分比较均无明显差异(P>0.05)。术后两组患者Oswestry功能障碍指数和VAS评分较术前均显著改善(P<0.05);术后1个月及术后3个月,研究组患者VAS评分均显著低于对照组(P<0.05);术后3个月,研究组患者Pfirrmann分级优于对照组(P<0.05);两组患者MMP-9和TIMP-1表达水平比较均无明显差异(P>0.05)。结论经皮椎间孔镜下腰椎间盘切除术治疗老年腰椎间盘突出症效果好,能有效减轻患者术后疼痛,促进其康复。Objective To investigate the clinical efficacy of percutaneous endoscopic lumbar discectomy treatment for elderly patients with lumbar disc herniation and its effect on matrix metalloproteinase-9 （MMP-9）. Method From December 2013 to October 2015, 116 cases of elderly patients with lumbar disc herniation in our hospital were randomly divided into research group and control group, 58 eases in each group. Control group patients were treated with microscopic discectomy, research group patients were treated with percutaneous transforaminal technique discectomy. The MMP-9 and TIMP-1 expression level of nucleus pulposus tissue of two groups were tested by Western blotting method. The operation time, incision length, fluoroscopy time, hospital stay, unable to work time, MMP-9 level, TIMP-1 level, VAS score and Oswestry disability index of the two groups were compared. Result The operation time, fluoroscopy time of research group were longer than control group （P 〈 0.05）, while incision length, hospital stay time, unable to work time were shorter （P 〈 0.05）. There were no significant differences in VAS score and Oswestry disability index between the two groups before surgery （P 〉 0.05）. After surgery, VAS score and Oswestry disability index of both groups decreased significantly （P 〈 0.05）. 1 month and 3 months after surgery, the VAS score and Oswestry dability index of research group were lower than control group （P 〈 0.05）. 3 months after surgery, Pfirrmann classification of research group was better than control group （P 〈 0.05）. There were no significant differences in MMP-9 and TIMP-1 level between the two groups （P 〉 0.05）. Conclusion Percutaneous endoscopic lumbar discectomy surgery has exact effect for lumbar disc herniation. It does well in reducing painful and promoting the rehabilitation after surgery.

关 键 词：经皮椎间孔镜 腰椎间盘突出症 基质金属蛋白酶 

分 类 号：R687.3[医药卫生—骨科学]