经椎间孔入路神经根封闭与神经电刺激治疗对腰椎间盘突出症患者疼痛评分、介质及下肢神经传导功能的影响  

Effects of Nerve Root Closure Via Intervertebral Foramen Approach and Electrical Nerve Stimulation on Pain Scores, Mediators and Nerve Conduction Function of the Lower Extremities in Patients with Lumbar Disc Herniation

作　　者：武永富[1] 庞江娜 赵欣[1] 赵林芳 田晓宾 王江泳[1] 冯建书[1] WU Yong-fu;PANG Jiang-na;ZHAO Xin;ZHAO Lin-fang;TIAN Xiao-bin;WANG Jiang-yong;FENG Jian-shu(the Third Hospital of Shijiazhuang Gity,the Third Department of Traumatofogy,Shijiazhuang 050011,China;the Third Hospital of Shijiazhuang Gity,the Second Department of Traumatofogy,Shijiazhuang 050011,China;the Fourth Department of Geriatrics,the Third Hospital of Shjiazhuang City,Shijiazhuang 050011,China;Department of Orthopedics,People's Hospital of Xingtang County,Xingtang,Hebei 050600,China)

机构地区：[1]石家庄市第三医院创伤三科,石家庄050011 [2]石家庄市第三医院创伤二科,石家庄050011 [3]石家庄市第一医院老年病四科,石家庄050011 [4]行唐县人民医院骨科,河北行唐050600

出　　处：《临床误诊误治》2022年第7期86-91,共6页Clinical Misdiagnosis & Mistherapy

基　　金：石家庄市科学技术研究与发展指导计划项目(161462533)。

摘　　要：目的 探讨经椎间孔入路神经根封闭与神经根电刺激对腰椎间盘突出症(LDH)患者疗效、疼痛评分与介质及下肢神经传导功能的影响。方法 选取2018年3月—2020年9月我院120例LDH,根据治疗方法的不同分为试验组与对照组各60例。试验组经椎间孔入路行神经根电刺激治疗,对照组经椎间孔入路行神经根封闭治疗。比较2组手术前后视觉模拟评分法(VAS)评分,疼痛介质[前列腺素E_(2)(PGE_(2))、5-羟色胺(5-HT)、β-内啡肽(β-EP)],胫神经、腓总神经运动神经传导速度(MCV)及腓浅神经、腓肠神经感觉神经传导速度(SCV),以及日本骨科学会(JOA)评分和安全性。结果 试验组术后1 d、7 d、3个月、6个月、12个月腰椎VAS评分低于对照组(P<0.05);试验组术后1 d、7 d、3个月、6个月、12个月血清PGE_(2)、5-HT低于对照组,β-EP高于对照组(P<0.05);试验组术后7 d、3个月、6个月、12个月腰椎JOA评分高于对照组(P<0.05);试验组术后3个月、6个月、12个月胫神经、腓总神经MCV及腓浅神经、腓肠神经SCV快于对照组(P<0.05);试验组术后3个月、6个月、12个月腰椎功能优良率高于对照组(P<0.01);2组术后均无相关并发症发生。结论 与经椎间孔入路神经根封闭治疗比较,采用经椎间孔入路神经根电刺激治疗LDH能获得更佳的效果,能进一步减轻患者疼痛程度、促进腰椎功能修复,且具有良好的安全性。Objective To investigate the effects of nerve root closure via intervertebral foramen approach and electrical stimulation of nerve root on the efficacy, pain score, mediator and nerve conduction function of lower extremity in patients with lumbar disc herniation(LDH).Methods A total of 120 cases of LDH in our hospital from March 2018 to September 2020 were selected and divided into the experimental group(n=60) and the control group(n=60) according to the treatment method. The experimental group underwent electrical stimulation of nerve root via intervertebral foramen approach, and the control group underwent nerve root closure via intervertebral foramen approach. The visual analogue scale(VAS) scores, pain mediators [prostaglandin E_(2)(PGE_(2)), 5-hydroxytryptamine(5-HT), β-endorphin(β-EP)], motor nerve conduction velocity(MCV) of the tibial and common peroneal nerves, sensory nerve conduction velocity(SCV) of the superficial peroneal and gastrocnemius nerves, the Japanese Orthopaedic Association(JOA) scores and safety were compared between the two groups before and after surgery. Results The lumbar VAS scores at 1 d, 7 d, 3 months, 6 months, and 12 months after surgery were lower in the experimental group than in the control group(P<0.05). Serum PGE_(2) and 5-HT were lower and β-EP was higher in the experimental group than in the control group at 1 d, 7 d, 3 months, 6 months, and 12 months after surgery(P<0.05). The lumbar JOA scores at 7 d, 3 months, 6 months, and 12 months after surgery in the experimental group were higher in the experimental group than in the control group(P<0.05). The MCV of the tibial and common peroneal nerves and the SCV of the superficial peroneal and peroneal nerves were faster in the experimental group than in the control group at 3, 6 and 12 months after surgery(P<0.05). The excellent and good rate of lumbar spine function was higher in the experimental group than in the control group at 3, 6 and 12 months after surgery(P<0.01). No related complications occurred in the two groups

关 键 词：椎间盘移位 神经根封闭 经皮神经电刺激 神经传导 视觉模拟评分法 前列腺素E_(2) 手术后并发症 

分 类 号：R681.53[医药卫生—骨科学]