| 郭龙,诸晖,陈冰,周嵘,陶德刚,赖爱宁,于凤宾,黄飞.后路经皮脊柱内镜下手术治疗神经根型颈椎病的临床疗效及对TXB2、TNF-α、NSE水平及血流动力学的影响[J].浙江中西医结合杂志,2025,35(4): |
| 后路经皮脊柱内镜下手术治疗神经根型颈椎病的临床疗效及对TXB2、TNF-α、NSE水平及血流动力学的影响 |
| The clinical efficacy of posterior percutaneous endoscopic surgery for cervical spondylotic radiculopathy and its effect on thromboxane B2, tumor necrosis factor-α, neuron-specific enolase and hemodynamics |
| 投稿时间：2024-04-15 修订日期：2025-02-19 |
| DOI： |
| 中文关键词: 神经根型颈椎病 后路 经皮脊柱内镜 椎间盘切除术 血流动力学 |
| 英文关键词: |
| 基金项目:湖州市科学技术局科研项目,编号:2021GY08 |
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| 中文摘要: |
| 目的 分析后路经皮脊柱内镜下手术治疗神经根型颈椎病的临床疗效及对血栓素B2(TXB2)、肿瘤坏死因子-α(TNF-α)、神经元特异性烯醇酶(NSE)水平及血流动力学的影响。方法 采取前瞻性对照研究,选择我院自2022年1月至2023年1月收治的120例神经根型颈椎病患者作为研究对象,随机分为观察组和对照组,各60例。观察组予以后路经皮脊柱内镜下手术治疗,对照组予以传统前路颈椎间盘切除融合术治疗。随访12个月,记录两组手术情况,通过颈椎功能障碍指数(NDI)、颈部疼痛视觉模拟评分(VAS)评估疗效,根据改良Macnab标准评估效果,比较手术前后颈椎生理曲度、病变椎间高度、血清TXB2、TNF-α、NSE水平、基底动脉、右椎动脉和左椎动脉的平均血流速度。结果 两组患者均顺利完成手术,未见严重并发症发生；其中观察组手术时间、首次下床时间、术后住院时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P＜0.05)；两组术后6个月、12个月的NDI指数、颈部VAS评分均较术前明显减小,差异有统计学意义(P＜0.05)；组间术前、12个月的NDI指数、颈部VAS评分比较,差异均无统计学意义(P＞0.05)；观察组术后6个月的NDI指数、颈部VAS评分均小于对照组,差异有统计学意义(P＜0.05)；观察组效果优良率为84.48%,对照组效果优良率为85.19%,等级分布差异无统计学意义(P＞0.05)；观察组术后6个月、12个月的颈椎生理曲度、病变椎间高度与术前比较,差异均无统计学意义(P＞0.05)；对照组术后6个月、12个月的颈椎生理曲度、病变椎间高度均较术前明显增大,且与观察组比较,差异有统计学意义(P＜0.05)；观察组术后1个月的血清TXB2、TNF-α、NSE水平均低于对照组,基底动脉、右椎动脉和左椎动脉的平均血流速度均大于对照组,差异有统计学意义(P＜0.05)。结论 后路经皮脊柱内镜下手术治疗神经根型颈椎病的临床疗效确切,在减小手术创伤上具有优势,能较好地降低血清TXB2、TNF-α、NSE水平和改善颈部血流动力学。 |
| 英文摘要: |
| Objective To analyze the clinical efficacy of posterior percutaneous endoscopic surgery for cervical spondylotic radiculopathy and its effect on thromboxane B2 (TXB2), tumor necrosis factor-α (TNF-α), neuron-specific enolase (NSE) and hemodynamics.Methods A prospective control study was conducted.120 patients with cervical spondylotic radiculopathy admitted to our hospital from January 2022 to January 2023 were selected as the research objects, and were randomly divided into observation group and control group, with 60 cases in each group. The observation group was treated with posterior percutaneous endoscopic surgery, and the control group was treated with traditional anterior cervical discectomy and fusion.After a follow-up of 12 months, the surgical conditions of the two groups were recorded. The efficacy was evaluated by cervical dysfunction index (NDI) and visual analogue scale (VAS) of neck pain. The efficacy was evaluated according to the modified Macnab standard. The physiological curvature of cervical spine, the height of lesion vertebral body, the levels of serum TXB2, TNF-α, NSE, the average blood flow velocity of basilar artery, right vertebral artery and left vertebral artery before and after surgery were compared.Results The operations of the two groups were successfully completed without serious complications.The operation time, first time out of bed time and postoperative hospital stay of the observation group were shorter than those of the control group, and the intraoperative blood loss was less than that of the control group, with significant differences (P<0.05). The NDI index and neck VAS scores of the two groups at 6 months and 12 months after operation were significantly decreased compared with those before operation, with significant differences (P<0.05); the NDI index and neck VAS scores before operation and 12 months after operation between the two groups were not significantly different (P>0.05); the NDI index and neck VAS scores of the observation group at 6 months after operation were significantly lower than those of the control group (P<0.05). The excellent and good rate was 84.48% in the observation group and 85.19% in the control group, and there was no significant difference in grade distribution (P>0.05). The cervical physiological curvature and the height of the lesion at 6 months and 12 months after operation were not significantly different from those before operation (P>0.05); the cervical physiological curvature and the height of the lesion at 6 months and 12 months after operation were significantly higher than those before operation, and compared with the observation group, the differences were significant (P<0.05). The serum TXB2, TNF-α and NSE levels of the observation group at 1 month after operation were lower than those of the control group, and the average blood flow velocity of the basilar artery, right vertebral artery and left vertebral artery were higher than those of the control group, with significant differences (P<0.05). Conclusion The clinical efficacy of posterior percutaneous endoscopic surgery for cervical spondylotic radiculopathy is reliable, which has advantages in reducing surgical trauma, and can better reduce the serum TXB2, TNF-α and NSE levels and improve the hemodynamics of the neck. |
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