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中华神经创伤外科电子杂志 ›› 2024, Vol. 10 ›› Issue (02) : 84 -90. doi: 10.3877/cma.j.issn.2095-9141.2024.02.004

临床研究

显微镜下周围神经松解术治疗腰椎间盘突出症术后残余神经症状的疗效分析
戴伟川1,†(), 郭协力1, 方仲宁1, 蔡文华1, 洪天生2, 田夏阳2   
  1. 1. 362200　福建晋江，晋江市医院（上海市第六人民医院福建医院）神经外科
    2. 362200　福建晋江，晋江市医院（上海市第六人民医院福建医院）康复理疗科
  • 收稿日期:2023-11-29 出版日期:2024-04-15
  • 通信作者: 戴伟川

Clinical efficacy of peripheral nerve release under microscope in the treatment of residual neurological symptoms after lumbar disc herniation

Weichuan Dai1,†(), Xieli Guo1, Zhongning Fang1, Wenhua Cai1, Tiansheng Hong2, Xiayang Tian2   

  1. 1. Department of Neurosurgery, Jinjiang Municipal Hospital (Fujian Hospital, Shanghai Sixth People's Hospital), Jinjiang 362200, China
    2. Department of Rehabilitation Therapy, Jinjiang Municipal Hospital (Fujian Hospital, Shanghai Sixth People's Hospital), Jinjiang 362200, China
  • Received:2023-11-29 Published:2024-04-15
  • Corresponding author: Weichuan Dai
  • Supported by:
    Health Science and Technology Plan Project of Fujian Province(2022CXA059); Clinical Special Project of Fujian University of Traditional Chinese Medicine(XB2021147); Science and Technology Project of Quanzhou, Fujian Province(2023NS098)
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引用本文：

戴伟川, 郭协力, 方仲宁, 蔡文华, 洪天生, 田夏阳. 显微镜下周围神经松解术治疗腰椎间盘突出症术后残余神经症状的疗效分析[J]. 中华神经创伤外科电子杂志, 2024, 10(02): 84-90.

Weichuan Dai, Xieli Guo, Zhongning Fang, Wenhua Cai, Tiansheng Hong, Xiayang Tian. Clinical efficacy of peripheral nerve release under microscope in the treatment of residual neurological symptoms after lumbar disc herniation[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2024, 10(02): 84-90.

目的

探讨显微镜下周围神经松解术治疗腰椎间盘突出症（LDH）患者术后残余神经症状的临床疗效。

方法

选取晋江市医院神经外科自2017年1月至2022年6月收治的LDH术后残余神经症状的患者89例，采用随机数字表法分为治疗组（46例）和对照组（43例）。对照组采取以电针为主的保守治疗，治疗组行周围神经松解术治疗。应用腰痛视觉模拟评分法（VAS）、日本骨科协会评估治疗分数（JOA）、改良Macnab疗效评分标准评估2组患者的疼痛、运动功能、临床疗效优良率；对比2组患者治疗前后的血清C反应蛋白（CRP)、肿瘤坏死因子-α（TNF-α）、白介素（IL）-6、IL-8；分析临床效果与治疗措施、炎症因子浓度的相关性。

结果

治疗组最终纳入41例，脱落5例，对照组最终纳入39例，脱落4例。2组患者的性别、年龄、病程、腰突部位等比较，差异无统计学意义（P>0.05）。2组患者治疗前VAS、JOA评分比较，差异无统计学意义（P>0.05）；治疗2、4、6周后，治疗组的VAS评分均低于对照组，JOA评分均高于对照组，血清CRP、TNF-α、IL-6、IL-8浓度水平均明显低于对照组，差异均有统计学意义（P<0.05）。治疗组治疗6周后的改良Macnab优良率高于对照组，反跳率低于对照组，差异均有统计学意义（P<0.05）。多元逐步回归方程结果显示，临床疗效（JOA评分）与治疗措施（电针、周围神经松解术）关系密切，与炎症因子浓度呈负相关。

结论

显微镜下周围神经松解术可以改善LDH患者术后残余神经症状，有望成为治疗LDH的新途径。

关键词: 腰椎间盘突出症, 残余神经症状, 康复治疗, 周围神经松解减压, 临床疗效, 炎症因子
Objective

To explore the clinical efficacy of peripheral nerve release under the microscope in the treatment of residual neurological symptoms in patients with lumbar disc herniation (LDH) after surgery.

Methods

Eighty-nine patients with residual neurological symptoms after LDH surgery admitted to Neurosurgery Department of Jinjiang Hospital from January 2017 to June 2022 were randomly divided into treatment group (46 cases) and control group (43 cases). The control group received conservative treatment mainly with electroacupuncture, while the treatment group received peripheral nerve release surgery. The visual analogue scale (VAS), Japanese Orthopedic Association (JOA), and the modified Macnab efficacy score standard were used to evaluate the pain, motor function, and excellent rate of clinical efficacy of two groups; Serum C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and IL-8 levels of two groups before and after treatment were compared; the correlation between clinical efficacy, treatment plan, and concentration of inflammatory factors were analyzed.

Results

The treatment group ultimately included 41 cases with 5 cases of dropout, while the control group ultimately included 39 cases with 4 cases of dropout. There was no statistically significant difference in gender, age, average disease duration, and lumbar process location between the two groups (P>0.05). There was no statistically significant difference in VAS and JOA scores between the two groups before treatment (P>0.05); After 2, 4, and 6 weeks of treatment, the VAS score of the treatment group was lower than that of the control group, and the JOA score was higher than that of the control group, and the concentration levels of serum CRP, TNF-α, IL-6, and IL-8 were significantly lower than those of the control group, the differences were statistically significant (P<0.05). The excellent and good rate of the treatment group after 6 weeks of treatment was higher than that of the control group, and the rebound rate was lower than that of the control group, with statistical significance (P<0.05). The results of multiple stepwise regression equation showed that the clinical efficacy (JOA score) was closely related to the treatment measures (electroacupuncture and peripheral neurolysis), and negatively correlated with the concentration of inflammatory factors.

Conclusion

Microscopic peripheral neurolysis can improve residual neurological symptoms in LDH patients after surgery, and is expected to become a new approach for the treatment of LDH.

Key words: Lumbar disc herniation, Residual neurological symptoms, Rehabilitation treatment, Peripheral neurolysis and decompression, Clinical effect, Inflammatory factors
表1 2组患者的一般资料比较
Tab.1 Comparison of general information between two groups
因素 治疗组（n=41） 对照组（n=39） χ2/t值 P值
性别     0.283 0.804
男 23 22    
女 18 17    
年龄（岁，±s） 39.54±12.69 38.12±13.43 0.486 0.628
病程（d，±s） 35.91±4.82 34.34±4.25 1.542 0.127
腰突部位     0.222 0.895
L3/4 8 7    
L4/5 21 22    
L5/S1 12 10    
表2 2组患者临床量表评分比较（±s）
Tab.2 Comparison of clinical scale scores between two groups (Mean±SD)
组别 例数 VAS评分 JOA评分
治疗前 治疗后2周 治疗后4周 治疗后6周 治疗前 治疗后2周 治疗后4周 治疗后6周
治疗组 41 5.82±1.75 2.24±1.28 0.94±0.28 0.84±0.21 10.56±2.73 22.36±1.46 25.01±1.54 27.01±1.72
对照组 39 5.94±1.23 4.34±0.45 4.06±1.23 4.72±1.08 10.32±2.96 10.65±1.15 13.18±1.61 11.08±1.21
t值   0.353 18.918 15.822 34.000 0.377 37.718 33.591 47.687
P值   0.725 <0.001 <0.001 <0.001 0.707 <0.001 <0.001 <0.001
表3 2组患者治疗6周后的改良Macnab优良率比较
Tab.3 Comparison of excellent and good rates of modified Macnab between two groups after 6 weeks of treatment
组别 例数 优 良 可 差 优良率（%）
治疗组 41 23 14 2 2 90.24
对照组 39 2 3 7 27 12.82
χ2值           48.045
P值           <0.001
表4 2组患者治疗6周后的反跳率比较
Tab.4 Comparison of rebound rates between two groups after 6 weeks of treatment
组别 例数 反跳 未反跳 反跳率（%）
治疗组 41 2 39 4.88
对照组 39 27 12 69.23
χ2值       35.818
P值       <0.001
表5 2组患者治疗前后炎症因子比较（±s）
Tab.5 Comparison of inflammatory factors between two groups (Mean±SD)
组别   治疗组（n=41） 对照组（n=39） t值 P值
CRP浓度（mg/L） 治疗前 12.94±2.78 12.89±2.59 0.083 0.934
治疗后2周 7.24±1.78 8.62±1.77 3.476 0.001
治疗后4周 5.64±1.42 7.62±1.43 6.213 <0.001
治疗后6周 5.24±1.28 10.42±2.29 12.569 <0.001
TNF-α浓度（ng/L） 治疗前 10.76±3.75 10.93±3.25 0.216 0.829
治疗后2周 3.95±0.75 8.36±1.46 17.116 <0.001
治疗后4周 3.65±0.55 6.69±1.21 4.585 <0.001
治疗后6周 3.24±0.28 7.36±1.27 20.267 <0.001
IL-6浓度（ng/L） 治疗前 2.04±0.78 2.16±0.17 0.940 0.350
治疗后2周 0.49±0.18 1.94±0.59 15.023 <0.001
治疗后4周 0.44±0.12 1.04±0.32 11.209 <0.001
治疗后6周 0.38±0.11 1.51±0.21 30.360 <0.001
IL-8浓度（ng/L） 治疗前 31.16±3.75 30.13±4.25 1.151 0.253
治疗后2周 14.15±3.17 27.31±2.46 20.671 <0.001
治疗后4周 10.65±2.55 22.42±1.25 26.001 <0.001
治疗后6周 9.24±1.21 24.16±1.07 58.310 <0.001
表6 JOA评分与治疗措施、炎症因子浓度的相关性
Tab.6 The correlation between JOA score, treatment measures, and concentration of inflammatory factors
变量 偏回归系数 标准误 标准化回归系数 r值 t值 P值
常数项 9.2361 2.1461 -      
X1 0.2145 0.2457 0.6571 0.7032 0.824 0.0246
X2 0.1578 0.2178 0.9126 0.9865 0.986 0.0104
X3 -0.2039 0.2104 -0.5542 0.6549 0.763 0.0304
X4 -0.2794 0.2164 -0.5034 0.5691 0.539 0.0397
X5 -0.2965 0.2197 -0.4689 0.5487 0.760 0.0421
X6 -0.1875 0.2798 -0.3791 0.5013 0.644 0.0351
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