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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/OL]. 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/OL]. 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
[1]
陈雪青,张金源,陈雪吟,等.牛痘疫苗接种家兔炎症皮肤提取物不同给药方式预防性治疗腰椎间盘突出术后残余神经症状的疗效[J].中国疼痛医学杂志, 2020, 26(1): 53-57. DOI: 10.3969/j.issn.1006-9852.2020.01.010.
[2]
杨洸,盛录,李亚楠,等.中医三联康复疗法治疗腰椎间盘突出症术后残余神经症状临床观察[J].风湿病与关节炎, 2018, 7(12): 16-19, 28. DOI: 10.3969/j.issn.2095-4174.2018.12.004.
[3]
庄素芳,叶佳,周小芳.加味乌头散火龙灸治疗寒湿型腰突症的临床效果观察[J].浙江中医药大学学报, 2020, 44(2): 207-210. DOI: 10.16466/j.issn1005-5509.2020.02.021.
[4]
Zhang R, Zhang SJ, Wang XJ. Postoperative functional exercise for patients who underwent percutaneous transforaminal endoscopic discectomy for lumbar disc herniation[J]. Eur Rev Med Pharmacol Sci, 2018, 22(1 Suppl): 15-22. DOI: 10.26355/eurrev_201807_15354.
[5]
Yan D, Zhang Z, Zhang Z. Residual leg numbness after endoscopic discectomy treatment of lumbar disc herniation[J]. BMC Musculoskelet Disord, 2020, 21(1): 273. DOI: 10.1186/s12891-020-03302-5.
[6]
Liu Y, Zhao J, Tian Y. Efficacy and safety of electroacupuncture in treatment of lumbar disc herniation: a protocol for a cohort study[J]. J Tradit Chin Med, 2019, 39(1): 127-132.
[7]
Qin QG, Chen ZJ, Fan WM, et al. Hyperpolarization-activated cyclic nucleotide-gated 2 contributes to electroacupuncture analgesia on lumbar disc herniation-induced radicular pain through activation of microglia in spinal dorsal horn[J]. J Tradit Chin Med, 2022, 42(3): 372-378. DOI: 10.19852/j.cnki.jtcm.2022.03.004.
[8]
Huang F, Xiao Z, Zhan X, et al. Tuina combined with adjuvant therapy for lumbar disc herniation: a network meta-analysis[J]. Complement Ther Clin Pract, 2022, 49: 101627. DOI: 10.1016/j.ctcp.2022.101627.
[9]
赵婷婷,赵耀东,蒋梅霞,等.针灸治疗寒湿型腰椎间盘突出症临床选穴规律研究[J].中医临床研究, 2020, 12(6): 120-123.
[10]
傅志辉.夹脊穴温针灸对腰椎间盘突出症患者腰椎功能的效果[J].吉林医学, 2023, 44(9): 2465-2467. DOI: 10.3969/j.issn.1004-0412.2023.09.023.
[11]
Chiarotto A, Maxwell LJ, Ostelo RW, et al. Measurement properties of visual analogue scale, numeric rating scale, and pain severity subscale of the brief pain inventory in patients with low back pain: a systematic review[J]. J Pain, 2019, 20(3): 245-263. DOI: 10.1016/j.jpain.2018.07.009.
[12]
Faiz KW. VAS--visual analog scale[J]. Tidsskr Nor Laegeforen, 2014, 134(3): 323. DOI: 10.4045/tidsskr.13.1145.
[13]
Heller GZ, Manuguerra M, Chow R. How to analyze the visual analogue scale: myths, truths and clinical relevance[J]. Scand J Pain, 2016, 13: 67-75. DOI: 10.1016/j.sjpain.2016.06.012.
[14]
Ishitani H, Tamura T, Kanaya S, et al. Examination of the regression model to quantify the degree of low back pain and lower limb symptoms in patients with lumbar disc herniation by the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ)[J]. PLoS One, 2020, 15(12): e0243861. DOI: 10.1371/journal.pone.0243861.
[15]
Komatsu J, Iwabuchi M, Endo T, et al. Clinical outcomes of lumbar diseases specific test in patients who undergo endoscopy-assisted tubular surgery with lumbar herniated nucleus pulposus: an analysis using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ)[J]. Eur J Orthop Surg Traumatol, 2020, 30(2): 207-213. DOI: 10.1007/s00590-019-02574-5.
[16]
Haro H, Ebata S, Inoue G, et al. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lumbar disc herniation, third edition-secondary publication[J]. J Orthop Sci, 2022, 27(1): 31-78. DOI: 10.1016/j.jos.2021.07.028.
[17]
Yamauchi T, Kim K, Isu T, et al. Undiagnosed peripheral nerve disease in patients with failed lumbar disc surgery[J]. Asian Spine J, 2018, 12(4): 720-725. DOI: 10.31616/asj.2018.12.4.720.
[18]
Shamim MS, Parekh MA, Bari ME, et al. Microdiscectomy for lumbosacral disc herniation and frequency of failed disc surgery[J]. World Neurosurg, 2010, 74(6): 611-616. DOI: 10.1016/j.wneu.2010.06.016.
[19]
李福汉,李福生,李凯.腰椎手术失败综合征失败原因的问题分析[J].系统医学, 2021, 6(12): 194-198. DOI: 10.19368/j.cnki.2096-1782.2021.12.194.
[20]
袁渤,杜明奎,匡正达.腰椎手术失败综合征的病因及治疗进展[J].中华灾害救援医学, 2017, 5(3): 164-167. DOI: 10.13919/j.issn.2095-6274.2017.03.011.
[21]
Rohde V, Mielke D, Ryang Y, et al. The immediately failed lumbar disc surgery: incidence, aetiologies, imaging and management[J]. Neurosurg Rev, 2015, 38(1): 191-195. DOI: 10.1007/s10143-014-0573-3.
[22]
伍京京.腰腿痛颗粒治疗腰椎间盘突出症术后残余症状的疗效观察[D].福州:福建中医药大学, 2017.
[23]
经历,罗选翔,潘彬,等.甲钴胺联合神经妥乐平治疗腰椎间盘突出症术后残余神经症状疗效观察[J].徐州医科大学学报, 2021, 41(4): 257-260. DOI: 10.3969/j.issn.2096-3882.2021.04.005.
[24]
任国玲,马丽,唐金环,等.中药熏蒸联合针灸对腰椎间盘突出症术后患者腰椎功能的影响[J].河南中医, 2015, 35(6): 1327-1329. DOI: 10.16367/j.issn.1003-5028.2015.06.0555.
[25]
曾朝辉,何林,赵金亮,等.强腰祛痛汤联合西药治疗腰椎间盘突出症经皮椎间孔镜髓核摘除术后残留神经症状疗效观察[J].湖南中医药大学学报, 2019, 39(12): 1521-1524. DOI: 10.3969/j.issn.1674-070X.2019.12.022.
[26]
孙剑,薛正海,刘维,等.电针深刺"腰突五穴"为主治疗腰椎间盘突出症临床研究[J].针灸临床杂志, 2020, 36(7): 26-29. DOI: 10.3969/j.issn.1005-0779.2020.07.008.
[27]
宋志明.电针联合综合康复治疗腰椎间盘突出症患者125例的临床疗效观察[J].中华物理医学与康复杂志, 2020, 42(1): 69-71. DOI: 10.3760/cma.j.issn.0254-1424.2020.01.017.
[28]
吕莹,戴德纯,姜慧娜,等.电针对不同多裂肌脂肪浸润率腰椎间盘突出症疗效的影响[J].中国针灸, 2021, 41(6): 593-597. DOI: 10.13703/j.0255-2930.20200817-k0006.
[29]
杨洸.腰椎间盘突出症术后残余神经症状与周围神经多重卡压的关联性探讨及"中医三联康复疗法"的疗效观察[D].福州:福建中医药大学, 2019.
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