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

Abstract: 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-α were (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 (10.63±1.96)° at 1 year postoperatively,respectively,for the small group，and (40.86±1.89)°,(1.72±0.28)cm,(10.63±2.15) scores,(39.15±2.11)°,(1.60±0.42)cm,(12.11±1.63) scores for the medium group,respectively,1 month postoperatively in the large volume group,(39.01±2.35)°,(1.61±0.29) cm,(11.20±2.75) scores,and (38.11±2.32)°,(1.43±0.33) cm,(13.24±1.52) scores at 1 year postoperatively,respectively,and the difference between the three groups were statistically significant (P<0.05).Conclusion PTED treatment of LDH can reduce the amount of grinding of the superior articular process during surgery,reduce operative time and intraoperative bleeding,alleviate inflammatory response,and achieve good short- and medium-term lumbar function and joint stability.

Key words: lumbar disc herniation;percutaneous endoscopic foraminal surgery;grinding amount of articular process;inflammatory index;biomechanical stability;lumbar function