内窥镜技术治疗有真空现象的椎间盘突出的临床效果分析及其发病机制研究  

Clinical Effect Analysis and Pathogenesis Study of Endoscopic Treatment for Intervertebral Disc Herniation with Vacuum Phenomenon

作　　者：甄瑞鑫[1] 赵红莲[1] 史凡祺 Chen Bin Zhen Ruixin;Zhao Honglian;Shi Fanqi;Chen Bin(Department of Minimally Invasive Spinal Surgery,South Campus,Affiliated Hospital of Chengde Medical College,Chengde 067000,China;不详)

机构地区：[1]承德医学院附属医院南院区微创脊柱外科,河北承德067000 [2]不详

出　　处：《南开大学学报（自然科学版）》2023年第3期52-60,共9页Acta Scientiarum Naturalium Universitatis Nankaiensis

基　　金：Supported by S&T Program of Hebei(19277711D)。

摘　　要：为了探讨经椎间孔内窥镜下髓核摘除术在具有真空征的椎间盘突出患者中的临床效果,回顾性收集接受经椎间孔内窥镜下髓核摘除术治疗的腰椎间盘突出症患者124例,包括非真空现象患者85例和真空现象患者39例,对比不同现象患者术后VAS评分、JOA评分、改善率和安全性评价.结果显示:术后真空组VAS评分由7.52±1.02分降至(3.44±0.97)分(t=3.5749,P=0.021),非真空组由(7.35±0.99)分降至(2.51±0.85)分(t=7.1125,P<0.001);术后3个月真空组JOA评分由(11.79±1.98)分上升到(14.72±1.66)分(t=2.0758,P=0.195),非真空组患者术后3个月的JOA评分由(12.21±2.01)分上升至(19.25±1.57)分(t=9.7745,P<0.001).真空征组患者术后C反应蛋白水平、术中出血量、24 h术后引流量、并发症发生率和复发率等指标均较高.经椎间孔入路内窥镜下髓核摘除术能够有效治疗腰椎间盘突出,但对于存在真空现象的患者,术后可能存在长期的腰臀部疼痛问题.分子动力学模拟为IGFBP6和IGF之间的相互作用提供了合理的解释,为研究腰椎间盘突出症可能的发病机理提供了有价值的信息.The primary goal of this research is to investigate the clinical effect of transforaminal endoscopic spine system in the treatment of lumbar disc protrusion with vacuum phenomenon.A total of 124 patients with lumbar disc protrusion underwent transforaminal endoscopic spine system,including 85 patients with the nonvacuum phenomenon and 39 patients with the vacuum phenomenon,were retrospectively collected.VAS score,JOA score,improvement rate,and safety evaluation of patients with different signs were compared.Results showed that after the surgery,the VAS score decreased from(7.52±1.02)to(3.44±0.97)in vacuum phenomenon group(t=3.5749,P=0.021),and from(7.35±0.99)to(2.51±0.85)in the non-vacum phenomenon group(t=7.1125,P<0.001).JOA score in the vacuum phenomenon group increased from(11.79±1.98)to(14.72±1.66)(t=-2.0758,P=0.195)in three monthes,and the non-vacuum phenomenon group increased from(12.21±2.01)to(19.25±1.57)(t=9.7745,P<0.001).Postoperative C-reactive protein level,intraoperative blood loss,24 h postoperative drainage volume,complication rate,and recurrence rate were all higher in vacum phenomenon group.In conclusion,the transforaminal endoscopic spine system can effectively treat lumbar disc protrusion,but for patients with the vacuum phenomena,there may be long-term lumbar pain.Molecular dynamics simulations between IGFBP6 and IGF were performed,which gives us more information for the investigation of the pathogeny of the lumbar disc protrusion.

关 键 词：腰椎间盘突出 真空现象 经椎间孔内窥镜下髓核摘除术 安全性 有效性 

分 类 号：R68[医药卫生—骨科学]