显微镜下周围神经松解术治疗腰椎间盘突出症术后残余神经症状的疗效分析  

Clinical efficacy of peripheral nerve release under microscope in the treatment of residual neurological symptoms after lumbar disc herniation

作　　者：戴伟川[1] 郭协力[1] 方仲宁 蔡文华[1] 洪天生 田夏阳 Weichuan Dai;Xieli Guo;Zhongning Fang;Wenhua Cai;Tiansheng Hong;Xiayang Tian(Department of Neurosurgery,Jinjiang Municipal Hospital(Fujian Hospital,Shanghai Sixth People's Hospital),Jinjiang 362200,China;Department of Rehabilitation Therapy,Jinjiang Municipal Hospital(Fujian Hospital,Shanghai Sixth People's Hospital),Jinjiang 362200,China)

机构地区：[1]晋江市医院(上海市第六人民医院福建医院)神经外科,福建晋江362200 [2]晋江市医院(上海市第六人民医院福建医院)康复理疗科,福建晋江362200

出　　处：《中华神经创伤外科电子杂志》2024年第2期84-90,共7页Chinese Journal Of Neurotraumatic Surgery:Electronic Edition

摘　　要：目的探讨显微镜下周围神经松解术治疗腰椎间盘突出症(LDH)患者术后残余神经症状的临床疗效。方法选取晋江市医院神经外科自2017年1月至2022年6月收治的LDH术后残余神经症状的患者89例,采用随机数字表法分为治疗组(46例)和对照组(43例)。对照组采取以电针为主的保守治疗,治疗组行周围神经松解术治疗。应用腰痛视觉模拟评分法(VAS)、日本骨科协会评估治疗分数(JOA)、改良Macnab疗效评分标准评估2组患者的疼痛、运动功能、临床疗效优良率;对比2组患者治疗前后的血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素(IL)-6、IL-8;分析临床效果与治疗措施、炎症因子浓度的相关性。结果治疗组最终纳入41例,脱落5例,对照组最终纳入39例,脱落4例。2组患者的性别、年龄、病程、腰突部位等比较,差异无统计学意义(P>0.05)。2组患者治疗前VAS、JOA评分比较,差异无统计学意义(P>0.05);治疗2、4、6周后,治疗组的VAS评分均低于对照组,JOA评分均高于对照组,血清CRP、TNF-α、IL-6、IL-8浓度水平均明显低于对照组,差异均有统计学意义(P<0.05)。治疗组治疗6周后的改良Macnab优良率高于对照组,反跳率低于对照组,差异均有统计学意义(P<0.05)。多元逐步回归方程结果显示,临床疗效(JOA评分)与治疗措施(电针、周围神经松解术)关系密切,与炎症因子浓度呈负相关。结论显微镜下周围神经松解术可以改善LDH患者术后残余神经症状,有望成为治疗LDH的新途径。Objective To explore the clinical efficacy of peripheral nerve release under the microscope in the treatment of residual neurological symptoms in patients with lumbar disc herniation(LDH)after surgery.Methods Eighty-nine patients with residual neurological symptoms after LDH surgery admitted to Neurosurgery Department of Jinjiang Hospital from January 2017 to June 2022 were randomly divided into treatment group(46 cases)and control group(43 cases).The control group received conservative treatment mainly with electroacupuncture,while the treatment group received peripheral nerve release surgery.The visual analogue scale(VAS),Japanese Orthopedic Association(JOA),and the modified Macnab efficacy score standard were used to evaluate the pain,motor function,and excellent rate of clinical efficacy of two groups;Serum C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α),interleukin(IL)-6 and IL-8 levels of two groups before and after treatment were compared;the correlation between clinical efficacy,treatment plan,and concentration of inflammatory factors were analyzed.Results The treatment group ultimately included 41 cases with 5 cases of dropout,while the control group ultimately included 39 cases with 4 cases of dropout.There was no statistically significant difference in gender,age,average disease duration,and lumbar process location between the two groups(P>0.05).There was no statistically significant difference in VAS and JOA scores between the two groups before treatment(P>0.05);After 2,4,and 6 weeks of treatment,the VAS score of the treatment group was lower than that of the control group,and the JOA score was higher than that of the control group,and the concentration levels of serum CRP,TNF-α,IL-6,and IL-8 were significantly lower than those of the control group,the differences were statistically significant(P<0.05).The excellent and good rate of the treatment group after 6 weeks of treatment was higher than that of the control group,and the rebound rate was lower than that of the control group,with st

关 键 词：腰椎间盘突出症 残余神经症状 康复治疗 周围神经松解减压 临床疗效 炎症因子 

分 类 号：R687.3[医药卫生—骨科学]