基于中医“因虚致瘀”论治结合微创手术对腰椎间盘突出症疗效及血TNF-α、IL-1β水平的影响  

Clinical Efficacy of Stasis Caused by Deficiency Combined With Minimally Invasive Surgery for Lumbar Disc Herniation and Effects of TNF-αand IL-1βin Peripheral Blood

作　　者：吴亚东[1] 齐晓艳[2] 韦庆申 鲁玉州 王金国[1] 汉吉健 WU Ya-dong;QI Xiao-yan;WEI Qing-shen(Department of Orthopedics,Rizhao Hospital of TCM,Rizhao,Shandong(276800),China)

机构地区：[1]山东省日照市中医医院骨伤三科,日照276800 [2]山东省日照市人民医院药剂科,日照276800

出　　处：《中国中西医结合外科杂志》2020年第3期536-541,共6页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：山东省中医药科技发展计划项目(2019-0805);济宁医学院教师科研扶持基金(JY2017FS050);日照市中医医院科研立项项目(RZZY2018LC-20)。

摘　　要：目的:根据中医"因虚致瘀理论"辨证结合经皮内窥镜下腰椎间盘髓核摘除术(PELD)治疗血瘀气滞型腰椎间盘突出症的疗效及对外周血肿瘤坏死因子-α(TNF-α)和白细胞介素-1β(IL-1β)水平的影响。方法:选取2016年1月-2018年4月日照市中医医院收治的血瘀气滞型腰椎间盘突出症患者90例,随机分为2组,治疗组45例采用益气和血方药配合PELD治疗,对照组45例采用PELD治疗,观测并比较2组术前和术后2周、2个月的Oswestry功能障碍指数(ODI)、疼痛评分(VAS)、血清TNF-α和IL-1β水平及住院天数。结果:两组均有40例患者获得随访,2组术后2周、2个月的ODI评分、VAS评分、TNF-α水平与治疗前比较均显著降低(P<0.01),2组术后2周、2个月IL-1β与治疗前比较,差异有统计学意义(P<0.05)。治疗组术后2周ODI评分、TNF-α水平优于同期对照组(P<0.05),治疗组术后2个月ODI评分、TNF-α水平优于同期对照组(P<0.05),治疗组术后2个月的VAS评分、IL-1β与对照组比较显著降低(P<0.01)。结论:血瘀气滞型腰椎间盘突出症行PELD术后结合中医"因虚致瘀"理论辨证论治,可降低术后外周血TNF-α和IL-1β水平,减轻术后疼痛,提高术后早期疗效,促进患者快速康复。Objective To observe the efficacy of“Stasis Caused by Deficiency Theory”combined with percutaneous endoscopic lumbar intervertebral discectomy(PELD)in the treatment of Qi stagnation and blood stasis of lumbar disc herniation and the effect of levels of Peripheral blood tumor necrosis factor-α(TNF-α)and interleukin-1β(IL-1β),further to explore the TCM theoretical mechanism and scientific connotation,and to provide new ideas for clinical diagnosis and treatment.Methods Statistical analysis of patients from January 2016 to April 2018,90 patients with Qi stagnation and blood stasis of lumbar disc herniation are randomly divided into 2 groups.45 patients in the treatment group were treated with qi benefiting and blood harmonizing herbal formulas and drugs combined with PELD,45 patients in the control group were only treated with PELD.The Oswestry dysfunction index(ODI),pain score(VAS),serum TNF-αlevel,IL-1βlevel and hospitalization days were recorded before and after surgery during the periods of 2 weeks and 2 months respectively.Results Both groups had 40 patients followed up,the ODI score,VAS score and TNF-αlevels were significantly lower than those before treatment at 2 weeks and 2 months after operation(P<0.01).There was a statistically significant difference in IL-1βat 2 weeks and 2 months after operation between the two groups compared with pretherapy(P<0.05).The ODI score and TNF-αlevels in the treatment group at 2 weeks and 2months after operation were better than those which in the same period of the control group(P<0.05).The VAS score and IL-1βin the treatment group were significantly lower than those in the control group at 2 months(P<0.01).Conclusion Treatment based on the theory of Stasis Caused by Deficiency in patients after PELD can reduce the levels of TNF-αand IL-1βin peripheral blood,reduce postoperative pain,improve early postoperative efficacy and promote rapid recovery of patients.

关 键 词：因虚致瘀理论 腰椎间盘突出症 肿瘤坏死因子-Α 白细胞介素-1Β 

分 类 号：R681.53[医药卫生—骨科学]