经皮椎间孔镜在腰椎间盘突出症患者髓核摘除术中的应用  

Application of Percutaneous Transforaminal Endoscopic Discectomy in Patients with Lumbar Disc Herniation

作　　者：王冰 陈利军 蔡建强 Wang Bing;Chen Lijun;Cai Jianqiang(Shangqiu Traditional Chinese Medicine Hospital,Shangqiu,Henan,476000,China)

机构地区：[1]商丘市中医院,河南商丘476000

出　　处：《黑龙江医学》2025年第5期531-534,共4页Heilongjiang Medical Journal

基　　金：2022年度河南省中医药科学研究专项课题(2022ZY1204)。

摘　　要：目的:研究经皮椎间孔镜在腰椎间盘突出症患者髓核摘除术中的应用效果。方法:选取2022年1月—2023年1月商丘市中医院收治的99例腰椎间盘突出症患者作为研究对象,依据不同手术方法分为对照组(n=48)和观察组(n=51)。对照组行椎板开窗术,观察组行经皮椎间孔镜髓核摘除术。比较两组患者围手术期指标、手术前后腰椎功能、腰部活动度、炎性反应[白细胞介素-17(IL-17)、肿瘤坏死因子-γ(TNF-γ)、白细胞介素-4(IL-4)]、疼痛介质[5-羟基色胺(5-HT)、β-内啡肽、P物质(SP)]水平及并发症发生情况。结果:与对照组患者相比,观察组患者切口长度、下床活动时间、住院时间、手术时间较短,输血量较少,差异均有统计学意义(t=31.274、16.050、9.355、28.098、20.591,P<0.05);术后1周,观察组患者血清TNF-γ、IL-17水平较对照组低,IL-4水平较对照组高,差异均有统计学意义(t=6.039、5.715、8.689,P<0.05);术后1周,观察组患者5-HT、SP水平较对照组低,β-内啡肽水平较对照组高,差异均有统计学意义(t=2.091、6.877、5.037,P<0.05);两组患者并发症发生率比较,差异无统计学意义(χ^(2)=0.323,P>0.05)。结论:经皮椎间孔镜髓核摘除术能促进腰椎间盘突出症患者腰椎功能恢复,减轻机体炎性反应,减少术后疼痛感。Objective:To study the application effect of percutaneous foraminal endoscopy in the removal of the nucleus pulposus in patients with lumbar disc herniation.Methods:A retrospective study was conducted on 99 patients with lumbar disc herniation treated in the hospital from January 2022 to January 2023.They were divided into control group(n=48)and observation group(n=51)based on different surgical methods.The control group underwent laminoplasty,while observation group underwent percutaneous foraminal endoscopic removal of the nucleus pulposus.Perioperative indicators,lumbar spine function before and after surgery,lumbar range of motion,and inflammatory response between two groups[interleukin-17(IL-17),tumor necrosis factor-γ(TNF)-γ,Interleukin-4(IL-4)],pain mediator[5-hydroxytryptamine(5-HT)β-levels of endorphins,substance P(SP)],and complications occurrence of two groups were compared.Results:Compared with the control group,incision length,time to get out of bed,surgery time and hospital stay,and less blood transfusion volume of the observation group are less(t=31.274,16.050,9.355,28.098,20.591;P<0.05).1 week after surgery,the serum levels of TNF-γand IL-17 in the observation group were lower than those in the control group,and the serum levels of IL-4 were higher than those in the control group,with statistically significant difference(t=6.039,5.715,8.689;P<0.05).1 week after surgery,the levels of 5-HT and SP of the observation group were lower than those in the control group,and the levels ofβ-endorphin in the control group were higher,with statistically significant difference(t=2.091,6.877,5.037;P<0.05).There was no significant difference in the incidence of complications between two groups(χ^(2)=0.323,P>0.05).Conclusion:Percutaneous lumbar discectomy can promote the recovery of lumbar function in patients with lumbar disc herniation,alleviate inflammatory reactions,reduce postoperative pain.

关 键 词：腰椎间盘突出 临床价值 髓核摘除术 腰部活动度 腰椎功能 

分 类 号：R681.51[医药卫生—骨科学]