腰椎间盘突出症内镜术前后脊柱-骨盆参数与腰背伸肌群功能的关系  

Relationship between preoperative and postoperative spino-pelvic parameters and function of lumbar dorsal extensor muscle groups in endoscopic lumbar disc herniation

作　　者：廉辉 蔡晓冰[2] 羊明智[3] LIAN Hui;CAI Xiao-bing;YANG Ming-zhi(Department of Orthopedics,Chongming Branch,Shanghai Tenth People's Hospital,Shanghai 202157,China;Department of Spine Surgery,The Tenth People's Hospital of Tongji University,Shanghai 200040,China;Department of Spine Surgery,The First Affiliated Hospital of Nanhua University,Hengyang Hunan 421001,China)

机构地区：[1]上海市第十人民医院崇明分院骨科,上海202157 [2]上海市同济大学附属第十人民医院脊柱外科,上海200040 [3]南华大学附属第一医院脊柱外科,湖南衡阳421001

出　　处：《颈腰痛杂志》2024年第6期1029-1034,共6页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨腰椎间盘突出症(LDH)患者内镜手术前后脊柱-骨盆影像学参数与腰背伸肌群功能、腰椎功能、疼痛程度及血清炎症因子的关系。方法以2021年7月至2023年7月在上海市第十人民医院崇明分院等3个医疗中心采用内镜手术治疗的120例LDH患者为研究对象,所有患者均在入院后及手术后7 d内测量骨盆侧倾(LPT)、腰椎前凸角(LL)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、矢状面垂直轴(SVA)参数,腰背伸状态下峰力矩、腰背屈伸比、平均功率,日本骨科协会下腰痛评价表(JOA)、Oswestry功能障碍指数(ODI)、视觉疼痛模拟评分(VAS),血清白细胞介素-1β(IL-1β)、白介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶3(MMP-3)水平,并进行相关性分析。结果术后LDH患者LPT、SVA较术前减小,LL、PI、SS较术前增大(P<0.05)。术后LDH患者腰背伸状态下峰力矩、平均功率较术前升高,腰背屈伸比较术前下降(P<0.05)。术后LDH患者JOA评分较术前升高,ODI、VAS评分、血清IL-1β、IL-1、TNF-α、MMP-3水平较术前下降(P<0.05)。LDH患者脊柱-骨盆影像参数LPT、SVA与腰背伸状态下峰力矩、平均功率、JOA评分呈负相关性,与腰背屈伸比、ODI、VAS评分、血清IL-1β、IL-1、TNF-α、MMP-3水平呈正相关性(P<0.05);LL、PI、SS与腰背伸状态下峰力矩、平均功率、JOA评分呈正相关性,与腰背屈伸比、ODI、VAS评分、血清IL-1β、IL-1、TNF-α、MMP-3水平呈负相关性(P<0.05)。结论术后LDH患者的脊柱-骨盆影像学参数与腰背伸肌群功能、腰椎功能、疼痛程度及血清炎症因子均发生一定改变,脊柱-骨盆影像学参数的改变可在一定程度上反映患者腰背伸肌群功能、腰椎功能、疼痛程度及炎症程度。Objective To investigate the relationship between spine-pelvis dimensional imaging parameters and the function of lumbar dorsal extensor muscle groups,lumbar spine function,pain level and serum inflammatory factor in patients with lumbar disc herniation(LDH)before and after surgery.Methods One hundred and twenty patients with LDH who were treated with endoscopic surgery in the hospital from July 2021 to July 2023 were studied,and all of them had the parameters of pelvic tilt(LPT),lumbar lordosis(LL),pelvic incidence(PI),pelvic tilt(PT),sacral tilt(SS),and sagittal vertical axis(SVA)measured after admission and 7 d after the surgery,the parameters of lumbar dorsiflexion state peak moment,lumbar dorsiflexion-extension ratio,and mean power,the Japanese Orthopaedic Association Lower Back Pain Assessment Scale(JOA),Oswestry Dysfunction Index(ODI),and Visual Analogue Score of Pain(VAS),and the serum interleukin-1β(IL-1β),interleukin-1(IL-1),tumour necrosis factor-alpha(TNF-α),and matrix metalloproteinase 3(MMP-3)levels,and the relationship between them was analyzed.Results Postoperative LPT and SVA decreased and LL,PI and SS increased in LDH patients compared to preoperative(P<0.05).Peak moment and mean power in the state of lumbar dorsiflexion in postoperative LDH patients were elevated compared with preoperative,and lumbar dorsiflexion-extension ratio decreased compared with preoperative(P<0.05).Postoperative JOA scores of LDH patients were higher than preoperative,and ODI,VAS scores,serum IL-1β,IL-1,TNF-α,and MMP-3 levels were lower than preoperative(P<0.05).Dimensional imaging parameters of the spine-pelvis of LDH patients,LPT and SVA,were negatively correlated with peak moments in the lumbar dorsiflexion state,mean power,and JOA scores,and negatively correlated with lumbar dorsiflexion-extension ratios,ODI,VAS score,serum IL-1β,IL-1,TNF-α,and MMP-3 levels were positively correlated(P<0.05);LL,PI,and SS were positively correlated with peak moments,mean power,and JOA score in the state of lumbar dorsiflexion

关 键 词：腰椎间盘突出症 内镜手术 脊柱-骨盆参数 腰背伸肌群 血清炎症因子 相关性 

分 类 号：R681.57[医药卫生—骨科学]