不同关节突磨削量在经皮椎间孔镜手术中的应用及对术后腰椎生物力学稳定性、炎性指标的影响  

Application of different articular process grinding amounts in percutaneous transforaminal endoscopic surgery and their effects on postoperative lumbar biomechanical stability,and inflammatory indicators

作　　者：甄瑞鑫[1] 赵红莲[2] 史凡祺 ZHEN Ruixin;ZHAO Honglian;SHI Fanqi(Minimally Invasive Spine Surgery,Operating Rooms,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微创脊柱外科,067000 [2]承德医学院附属医院手术室,067000

出　　处：《临床外科杂志》2025年第3期313-316,共4页Journal of Clinical Surgery

基　　金：河北省重点研发计划(民生科技专项)项目(19277711D)。

摘　　要：目的探讨经皮椎间孔镜手术(PTED)中不同关节突磨削量对患者腰椎生物力学稳定性、炎性反应的影响。方法2018年1月~2020年10月收治的腰椎间盘突出症(LDH)病人195例,随机数字表法分成三组,每组各65例,均实施PTED,术中上关节突关节磨削量<33%者为少量组,磨削量33%~50%者为中量组,>50%者为大量组。观察三组病人手术相关指标、手术前后不同时间点炎性指标[白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α]、生物力学稳定性、腰椎功能恢复评分。结果少量组手术时间、术中出血量分别为(61.32±7.86)分钟和(11.85±1.10)ml,中量组分别为,(70.06±8.53)分钟和(14.32±2.21)ml,大量组分别为(74.47±10.00)分钟和(19.86±3.00)ml,三组比较差异有统计学意义(P<0.05)。少量组血清IL-6、TNF-α术后3天分别为(6.10±1.12)pg/ml和(8.21±1.87)ng/L,出院时分别为(3.27±0.58)pg/ml和(4.32±1.00)ng/L;中量组术后3天分别为(6.68±1.35)pg/ml和(9.00±1.20)ng/L,出院时分别为(4.10±0.63)pg/ml和(6.85±1.28)ng/L;大量组术后3天分别为(7.32±1.00)pg/ml和(10.57±1.28)ng/L,出院时分别为(4.57±0.49)pg/ml和(8.14±1.35)ng/L;三组比较差异有统计学意义(P<0.05)。少量组血清腰椎前凸角度、腰椎屈曲、腰椎稳定评分术后1个月分别为(42.28±2.12)°、(1.86±0.36)cm、(10.52±2.01)分,术后1年分别为(42.11±1.97)°、(1.87±0.52)cm、(10.63±1.96)分,中量组术后1个月分别为(40.86±1.89)°、(1.72±0.28)cm、(10.63±2.15)分,术后1年分别为(39.15±2.11)°、(1.60±0.42)cm、(12.11±1.63)分,大量组术后1个月分别为(39.01±2.35)°、(1.61±0.29)cm、(11.20±2.75)分,术后1年分别为(38.11±2.32)°、(1.43±0.33)cm、(13.24±1.52)分,三组比较差异有统计学意义(P<0.05)。结论PTED治疗LDH术中减少上关节突磨削量,能减少手术时间及术中出血量,减轻炎症反应,可获得良好的近中期腰椎功能及关节稳定性疗效。Objective To explore the effects of different grinding amounts of articular processes on the biomechanical stability and inflammatory response of lumbar spine during percutaneous foraminoscopic surgery(PTED).Methods A total of 195 patients with lumbar disc herniation(LDH)in our hospital were selected for prospective study from January 2018 to October 2020,and they were divided into three groups by randomized numerical table method,each with 65 cases,and all of them were implemented PTED.Patients with intraoperative upper joint process grinding<33%were treated as a small group,patients with intraoperative grinding<33%~50%were treated as a medium group,and patients with>50%were treated as a large group.The surgery-related indexes of the three groups of patients were observed,as well as the inflammatory indexes[interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α)],biomechanical stability,and joint functional recovery scores at different time points before and after surgery.Results The operation time and intraoperative bleeding were(61.32±7.86)min and(11.85±1.10)ml in the small group,(70.06±8.53)min and(14.32±2.21)ml in the medium group,and(74.47±10.00)min and(19.86±3.00)ml in the large group,and the differences among the three groups were statistically significant(P<0.05).Serum IL-6 and TNF-αwere(6.10±1.12)pg/ml and(8.21±1.87)ng/L in the small group 3d postoperatively,and(3.27±0.58)pg/ml and(4.32±1.00)ng/L in the discharge group,and in the medium group 3d postoperatively,they were(6.68±1.35)pg/ml and(9.00±1.20)ng/L at discharge and(4.10±0.63)pg/ml and(6.85±1.28)ng/L at discharge,respectively,and(7.32±1.00)pg/ml and(10.57±1.28)ng/L in the massive group at 3d postoperatively and(4.57±0.49)pg/ml and(8.14±1.35)ng/L at discharge,and the difference between the three groups was statistically significant(P<0.05);the serum lumbar lordosis angle,lumbar flexion,and lumbar stability scores were(42.28±2.12)°,(1.86±0.36)cm,and(10.52±2.01)°at 1 month postoperatively,and(42.11±1.97)°,(1.87±0.52)cm,and(

关 键 词：腰椎间盘突出症 经皮椎间孔镜手术 关节突磨削量 炎性指标 生物力学稳定性 腰椎功能 

分 类 号：R68[医药卫生—骨科学]