椎间孔镜手术与传统开窗手术治疗腰椎间盘突出症的术后疼痛介质、炎性因子比较

摘要

Objective:To compare the differences in pain mediators and inflammatory factors after percutaneous transforaminal endoscopic discectomy and traditional fenestration operation treatment of protrusion of lumbar intervertebral disc. Methods:A total of 80 patients with protrusion of lumbar intervertebral disc treated in our hospital were collected and divided into observation group and control group (n =40)according to randomized parallel contrast.Control group received traditional fenestration operation and observation group received percutaneous transforaminal endoscopic discectomy.Before operation and 1 week after operation,fluorescence spectrophotometry was used to determine serum pain medium levels;ELISA was used to determine pro-inflammatory factor and anti-inflammatory factor levels.Results:Before undergoing operation,differences in serum pain medium and inflammatory factor levels were not statistically significant between two groups (P >0.05).1 week after operation,serum pain media norepinephrine (NE),dopamine (DA),5-hydroxytryptamine (5-HT),prostaglandin E2 (PGE2) and substance P (SP)levels as well as pro-inflammatory factors interleukin-1β(IL-1β),interleukin-6 (IL-6),interleukin-18(IL-18)and tumor necrosis factor alpha (TNF-α)levels of observation group were lower than those of control group while serum anti-inflammatory factors interleukin-4 (IL-4),interleukin 10 (IL-10),soluble tumor necrosis factor receptorⅠ (sTNFRI) levels were higher than those of control group,and differences between groups were statistically significant (P <0.05). Conclusion:Percutaneous transforaminal endoscopic discectomy can effectively treat protrusion of lumbar intervertebral disc and is more advantageous in alleviating patients’perception of pain and reducing inflammation.%目的：：对比椎间孔镜手术与传统开窗手术治疗腰椎间盘突出症的术后疼痛介质、炎性因子差异.方法：收集本院收治的腰椎间盘突出症患者80例，随机分为观察组及对照组各40例.对照组接受传统开窗手术治疗，观察组接受椎间孔镜手术治疗.术前、术后1周，采用荧光分光光度法测定血清疼痛介质含量；采用 ELISA 测定促炎因子及抗炎因子含量.结果：术前，两组血清疼痛介质、炎性因子含量比较，差异无统计学意义(P ＞0．05).术后1周，观察组的血清疼痛介质去甲肾上腺素(NE)、多巴胺(DA)、5-羟色胺(5-HT)、前列腺素 E2(PGE2)、P 物质(SP)含量以及促炎因子白介素-1β(IL-1β)、白介素-6(IL-6)、白介素-18(IL-18)、肿瘤坏死因子-α(TNF-α)含量低于对照组，血清抗炎因子白介素-4(IL-4)、白介素-10(IL-10)、可溶性肿瘤坏死因子Ⅰ型受体(sTNF-RI)含量高于对照组，组间差异有统计学意义(P ＜0．05).结论：椎间孔镜手术可以有效治疗腰椎间盘突出症，在缓解患者疼痛感受、降低炎症反应方面更具优势.