椎间孔镜手术对腰椎间盘突出症患者术后疼痛介质、炎性因子的影响

黎志权

【摘要】 目的：探讨椎间孔镜手术治疗腰椎间盘突出症的临床效果以及术后对疼痛介质、炎性因子的影响。方法：选择2016年1月-2017年6月在本院治疗的腰椎间盘突出症患者160例，隨机分为对照组和观察组，每组各80例。对照组采用传统开窗手术治疗，观察组采用椎间孔镜手术治疗。比较两组的治疗总有效率，手术前后前列腺素E2（PGE2）、5-羟色胺（5-HT）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）和肿瘤坏死因子-α（TNF-α）水平变化。结果：术后，两组5-HT及PGE2水平均明显低于术前（P<0.05），观察组的5-HT及PGE2水平明显低于对照组（P<0.05）;两组术前IL-6、IL-8、TNF-α水平比较，差异均无统计学意义（P>0.05）;术后，两组的IL-6、IL-8、TNF-α水平均明显低于术前（P<0.05），观察组各炎性因子水平均明显低于对照组（P<0.05）。观察组治疗总有效率（93.75%）与对照组治疗总有效率（91.25%）比较，差异无统计学意义（P>0.05）。结论：椎间孔镜手术治疗腰椎间盘突出症能够有效缓解患者疼痛，降低血清炎性因子水平，效果显著。

【关键词】 椎间孔镜; 腰椎间盘突出症; 疼痛介质; 炎性因子

【Abstract】 Objective：To explore the clinical effect of transforaminal endoscopic surgery in the treatment of lumbar disc herniation，and the effect of postoperative pain mediators and inflammatory factors.Method：160 cases of lumbar disc herniation treated in our hospital from January 2016 to June 2017 was randomly divided into control group and observation group，80 cases in each group.The control group was treated with traditional fenestration.The observation group was treated with transforaminal endoscopic surgery.The total effective rate of two groups were compared，and the levels of prostaglandin E2（PGE2），5-hydroxytryptamine（5-HT），interleukin-6（IL-6），interleukin-8（IL-8）and tumor necrosis factor-α（TNF-α）before and after surgery were compared.Result：After surgery，the levels of 5-HT and PGE2 in the two groups were significantly lower than those before surgery（P<0.05），and the level of 5-HT and PGE2 in the observation group were significantly lower than those of the control group（P<0.05）.The IL-6，IL-8，TNF-α levels between the two groups before surgery were compared，the differences were no statistically significant（P>0.05）.After surgery，the levels of IL-6，IL-8 and TNF-α in both groups were significantly lower than those before the operation（P<0.05），and the levels of inflammatory factors in the observation group were significantly lower than those in the control group（P<0.05）.The effective rate of treatment in the observation group（93.75%）was compared with that in the control group（91.25%），the difference was no statistically significant（P>0.05）.Conclusion：Transforaminal endoscopic surgery for lumbar disc herniation can effectively relieve pain and reduce the level of serum inflammatory factors，the effect is significant.

【Key words】 Transforaminal endoscopic; Lumbar disc herniation; Pain mediators; Inflammatory factor

First-authors address：Luoding Traditional Chinese Medicine Hospital，Luoding 527200，China

doi：10.3969/j.issn.1674-4985.2019.16.033

腰椎间盘突出症是因椎间盘退行性改变、纤维环破裂导致髓核突出，进而压迫周围脊神经根产生疼痛、麻木等症状，严重影响患者日常行动及生活质量[1]。在发病早期患者可通过保守治疗改善症状，恢复腰椎功能，但是仍有部分患者保守治疗效果不佳需要手术治疗。传统开放手术是临床治疗腰椎间盘突出症的常用术式，操作简单，效果显著，但是其仍存在着手术创伤大、对脊柱结构损害严重、容易出血术后疼痛剧烈等不足[2]。近年来，微创技术在腰椎间盘突出症治疗方面的应用发展，但普通的微创手术无法直视髓核组织，适应证较少，而椎间孔镜手术拓宽了腰椎间盤突出手术治疗的适应证，减轻了手术创伤[3-4]。为进一步明确腰椎间孔镜手术与传统开放手术治疗腰椎间盘突出症的临床价值，本研究对采用两种手术方式治疗后患者的疼痛介质及炎症因子水平进行了分析，现结果报道如下。……