经皮激光汽化术联合杜仲腰痛丸治疗腰椎间盘突出症的效果观察
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摘要
目的:研究经皮激光汽化术联合杜仲腰痛丸治疗腰椎间盘突出症的临床效果。方法:选择2016年4月~2018年4月我院脊柱骨科收治的106例腰椎间盘突出症患者,随机分为两组。对照组单独采用经皮激光汽化术治疗,观察组联合口服杜仲腰痛丸治疗,每次8粒,每天3次。比较两组的治疗有效率,治疗前后的VAS评分、JOA评分,血清白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)水平的改变情况。结果:治疗后,观察组的治疗有效率为88.68%(47/53),明显高于对照组[73.58%(39/53)](P<0.05)。两组治疗后的VAS评分值均较治疗前明显降低(P<0.05),JOA评分值均较对照组明显升高(P<0.05),且观察组VAS评分值明显低于对照组,JOA评分值显著高于对照组(P<0.05)。两组治疗后的血清IL-1β、TNF-α水平均较治疗前明显降低(P<0.05),且观察组血清IL-1β、TNF-α水平明显低于对照组(P<0.05)。两组均未发生神经损伤和无椎间盘炎等并发症。结论:经皮激光汽化术联合杜仲腰痛丸治疗腰椎间盘突出症的临床效果明显优于单独采用经皮激光汽化术治疗,其可以显著改善患者的生活质量,降低疼痛程度,其作用机制可能与有降低患者血清炎症介质IL-1β、TNF-α的表达有关。
Objective: To investigate the clinical effect of percutaneous laser vaporization combined with duzhongyaotong pill in the treatment of lumbar disc herniation. Methods: 106 cases of patients with lumbar disc herniation who were treated in our hospital from April 2016 to April 2018 were selected and randomly divided into two groups. The control group was treated with percutaneous laser vaporization alone, and the observation group was treated with duzhongyaotong pill orally, 8 capsules each time, 3 times a day. The therapeutic efficacy, changes of VAS score, JOA score, serum interleukin-1β(IL-1β) and tumor necrosis factor-α(TNF-α) levels before and after treatment were compared between the two groups. Results: After treatment, the effective rate of observation group was 88.68%(47/53), which was significantly higher than that of control group [73.58%(39/53)](P<0.05). After treatment, the VAS scores of both groups were significantly lower than those before treatment(P<0.05), while the JOA scores were significantly higher than those before treatment(P<0.05), and the VAS scores of observation group were significantly lower than those of the control group, and the JOA scores were significantly higher than those of the control group(P <0.05). The serum levels of IL-1β and TNF-α in both groups were significantly lower than those before treatment(P <0.05), and the serum levels of IL-1β and TNF-α in the observation group were significantly lower than those in the control group(P<0.05). No neurological injury or intervertebral disc inflammation occurred in the two groups. Conclusion: The clinical effect of percutaneous laser vaporization combined with duzhongyaotong pill in the treatment of lumbar intervertebral disc herniation was better than that of percutaneous laser vaporization alone, which can significantly improve the quality of life of patients and reduce the degree of pain, and its mechanism may be related to the reduction of serum inflammatory mediators IL-1β and TNF-α expression.
Objective: To investigate the clinical effect of percutaneous laser vaporization combined with duzhongyaotong pill in the treatment of lumbar disc herniation. Methods: 106 cases of patients with lumbar disc herniation who were treated in our hospital from April 2016 to April 2018 were selected and randomly divided into two groups. The control group was treated with percutaneous laser vaporization alone, and the observation group was treated with duzhongyaotong pill orally, 8 capsules each time, 3 times a day. The therapeutic efficacy, changes of VAS score, JOA score, serum interleukin-1β(IL-1β) and tumor necrosis factor-α(TNF-α) levels before and after treatment were compared between the two groups. Results: After treatment, the effective rate of observation group was 88.68%(47/53), which was significantly higher than that of control group [73.58%(39/53)](P<0.05). After treatment, the VAS scores of both groups were significantly lower than those before treatment(P<0.05), while the JOA scores were significantly higher than those before treatment(P<0.05), and the VAS scores of observation group were significantly lower than those of the control group, and the JOA scores were significantly higher than those of the control group(P <0.05). The serum levels of IL-1β and TNF-α in both groups were significantly lower than those before treatment(P <0.05), and the serum levels of IL-1β and TNF-α in the observation group were significantly lower than those in the control group(P<0.05). No neurological injury or intervertebral disc inflammation occurred in the two groups. Conclusion: The clinical effect of percutaneous laser vaporization combined with duzhongyaotong pill in the treatment of lumbar intervertebral disc herniation was better than that of percutaneous laser vaporization alone, which can significantly improve the quality of life of patients and reduce the degree of pain, and its mechanism may be related to the reduction of serum inflammatory mediators IL-1β and TNF-α expression.
引文
[1] Manchikanti L, Pampati V, Benyamin R M, et al. Cost Utility Analysis of Lumbar Interlaminar Epidural Injections in the Treatment of Lumbar Disc Herniation, Central Spinal Stenosis, and Axial or Discogenic Low Back Pain[J]. Pain Physician, 2017, 20(4):219
[2] Gu Y, Cui Z, Shao H, et al. Percutaneous transforaminal endoscopic surgery(PTES)for symptomatic lumbar disc herniation:a surgical technique, outcome, and complications in 209 consecutive cases[J].Journal of Orthopaedic Surgery&Research, 2017, 12(1):25
[3] Liu C, Chu L, Yong H C, et al. Percutaneous Endoscopic Lumbar Discectomy for Highly Migrated Lumbar Disc Herniation[J]. Pain Physician, 2017, 20(1):E75
[4] Tu Z, Li Y W, Wang B, et al. Clinical Outcome of Full-endoscopic Interlaminar Discectomy for Single-level Lumbar Disc Herniation:A Minimum of 5-year Follow-up[J]. Pain Physician, 2017, 20(3):E425
[5] Lv Y, Chen J, Chen J, et al. Three-year postoperative outcomes between MIS and conventional TLIF in1-segment lumbar disc herniation[J]. Minim Invasive Ther Allied Technol, 2017, 26(3):1-12
[6] Tian Q H, Lu Y Y, Sun X Q, et al. Feasibility of Percutaneous Lumbar Discectomy Combined with Percutaneous Cementoplasty for Symptomatic Lumbar Disc Herniation with Modic Type I Endplate Changes[J]. Pain Physician, 2017, 20(4):E481
[7] Dagistan Y, Cukur S, Dagistan E, et al. Role of Expression of Inflammatory Mediators in Primary and Recurrent Lumbar Disc Herniation[J]. Journal of Korean Neurosurgical Society, 2017, 60(1):40-46
[8] Zhong M, Liu J T, Jiang H, et al. Incidence of Spontaneous Resorption of Lumbar Disc Herniation:A Meta-Analysis[J]. Pain Physician,2017, 20(1):E45
[9] Feng F, Xu Q, Yan F, et al. Comparison of 7 Surgical Interventions for Lumbar Disc Herniation:A Network Meta-analysis[J]. Pain Physician, 2017, 20(6):E863
[10] Deng Q, Junjie L I, Zhang Y, et al. Clinical Observation on the Treatment of Thoracic and Lumbar Vertebral Tuberculosis with Incomplete Paralysis Based on the Theory of Du Meridian[J]. Chinese Journal of Traditional Medical Traumatology&Orthopedics, 2018,(2):23-27
[11] Ikuta K, Tarukado K, Masuda K. Characterization and Risk Factor Analysis for Recurrence Following Microendoscopic Diskectomy for Lumbar Disk Herniation[J]. J Neurol Surg A Cent Eur Neurosurg,2017, 78(02):154-160
[12] Zoia C, Bongetta D, Poli J C, et al. Intraregional differences of perioperative management strategy for lumbar disc herniation:is the Devil really in the details?[J]. International Journal of Spine Surgery,2017, 11(1):1
[13] Moon S H, Lee J I, Cho H S, et al. Factors for Predicting Favorable Outcome of Percutaneous Epidural Adhesiolysis for Lumbar Disc Herniation[J]. Pain Research&Management, 2017, 2017(9):1-10
[14] Eun S S, Eum J H, Lee S H, et al. Biportal Endoscopic Lumbar Decompression for Lumbar Disk Herniation and Spinal Canal Stenosis:A Technical Note[J]. J Neurol Surg A Cent Eur Neurosurg,2017, 78(04):390-396
[15] Sadeghian H, Motieilangroudi R. Pitting Oedema in a Patient with Lumbar Disc Herniation:Case report of an unusual association[J].Sultan Qaboos University Medical Journal, 2017, 17(4):e464
[16] Xie T H, Zeng J C, Li Z H, et al. Complications of Lumbar Disc Herniation Following Full-endoscopic Interlaminar Lumbar Discectomy:A Large, Single-Center, Retrospective Study[J]. Pain Physician, 2017, 20(3):E379
[17] Hai-Hao W U, Tang T, Pang Q J, et al. Percutaneous endoscopic lumbar discectomy combined with epidural injection for prolapsed lumbar disc herniation[J]. China Journal of Orthopaedics&Traumatology, 2017, 30(2):110-114
[18] Chen B L, Guo J B, Zhang H W, et al. Surgical versus non-operative treatment for lumbar disc herniation:a systematic review and metaanalysis[J]. Clinical Rehabilitation, 2018, 32(2):269215517719 952
[19] Dat W, Grotle M, Gulati S, et al. Criteria for failure and worsening after surgery for lumbar disc herniation:a multicenter observational study based on data from the Norwegian Registry for Spine Surgery.[J]. European spine journal:official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2017, 26(Suppl 3):1-10
[20] Zhang Y, Yin Q, Zhu M, et al. Collagenase chemonucleolysis versus percutaneous endoscopic discectomy for extraforaminal lumbar disc herniations[J]. International Journal of Clinical&Experimental Medicine, 2017, 10(5):8610-8619
[21] Karademir M, Eser O, Karavelioglu E. Adolescent lumbar disc herniation:Impact, diagnosis, and treatment[J]. Journal of Back&Musculoskeletal Rehabilitation, 2017, 30(2):347
[22] Fei H, Li W S, Sun Z R, et al. Analysis of Spino-pelvic Sagittal Alignment in Young Chinese Patients with Lumbar Disc Herniation[J]. Orthop Surg, 2017, 9(3):271-276
[23] Zhao J, Zhang H, Zhao S, et al. The Effects of DuZhong YaoTong Pills Combined with XiaoDing Ointment on Low Back Pain after the Surgery of LDH[J]. Western Journal of Traditional Chinese Medicine,2017, 30(11):1-4
[24] Guo Z, Hongchao Y U, Shi D, et al. Curative effect of massage,acupuncture with traction-reduction on prolapse of lumbar intervertebral disc and on serum IL-1βand TNF-αin the patients[J].Modern Journal of Integrated Traditional Chinese&Western Medicine, 2017, 26(19):2064-2066
[25] Wang F,Wang K, Xu W, et al. SIRT5 Desuccinylates and Activates Pyruvate Kinase M2 to Block Macrophage IL-1βProduction and to Prevent DSS-Induced Colitis in Mice[J]. Cell Reports, 2017, 19(11):2331-2344
[26] Weichand B, Popp R, Dziumbla S, et al. S1PR1 on tumor-associated macrophages promotes lymphangiogenesis and metastasis via NLRP3/IL-1β[J]. Journal of Experimental Medicine, 2017, 214(9):2695-2713
[27] Martínsánchez F, Martínezgarcía J J, Mu觡ozgarcía M, et al. Lytic cell death induced by melittin bypasses pyroptosis but induces NLRP3 inflammasome activation and IL-1βrelease[J]. Cell Death&Disease, 2017, 8(8):e2984
[28] Wang F, Jiang Y, Huang X, et al. Pro-Inflammatory Cytokine TNF-αAttenuates BMP9-Induced Osteo/Odontoblastic Differentiation of the Stem Cells of Dental Apical Papilla(SCAPs)[J]. Cellular Physiology&Biochemistry International Journal of Experimental Cellular Physiology Biochemistry&Pharmacology, 2017, 41(5):1725
[29] Wu G R, Mu T C, Gao Z X, et al. Prion protein is required for tumor necrosis factor alpha(TNFα)-triggered nuclear factor kappa B(NF-κB)signaling and cytokine production[J]. Journal of Biological Chemistry, 2017, 292(46):18747-18759
[30] Hartley G, Regan D, Guth A, et al. Regulation of PD-L1 expression on murine tumor-associated monocytes and macrophages by locally produced TNF-α[J]. Cancer Immunology Immunotherapy, 2017, 66(4):523-535
[2] Gu Y, Cui Z, Shao H, et al. Percutaneous transforaminal endoscopic surgery(PTES)for symptomatic lumbar disc herniation:a surgical technique, outcome, and complications in 209 consecutive cases[J].Journal of Orthopaedic Surgery&Research, 2017, 12(1):25
[3] Liu C, Chu L, Yong H C, et al. Percutaneous Endoscopic Lumbar Discectomy for Highly Migrated Lumbar Disc Herniation[J]. Pain Physician, 2017, 20(1):E75
[4] Tu Z, Li Y W, Wang B, et al. Clinical Outcome of Full-endoscopic Interlaminar Discectomy for Single-level Lumbar Disc Herniation:A Minimum of 5-year Follow-up[J]. Pain Physician, 2017, 20(3):E425
[5] Lv Y, Chen J, Chen J, et al. Three-year postoperative outcomes between MIS and conventional TLIF in1-segment lumbar disc herniation[J]. Minim Invasive Ther Allied Technol, 2017, 26(3):1-12
[6] Tian Q H, Lu Y Y, Sun X Q, et al. Feasibility of Percutaneous Lumbar Discectomy Combined with Percutaneous Cementoplasty for Symptomatic Lumbar Disc Herniation with Modic Type I Endplate Changes[J]. Pain Physician, 2017, 20(4):E481
[7] Dagistan Y, Cukur S, Dagistan E, et al. Role of Expression of Inflammatory Mediators in Primary and Recurrent Lumbar Disc Herniation[J]. Journal of Korean Neurosurgical Society, 2017, 60(1):40-46
[8] Zhong M, Liu J T, Jiang H, et al. Incidence of Spontaneous Resorption of Lumbar Disc Herniation:A Meta-Analysis[J]. Pain Physician,2017, 20(1):E45
[9] Feng F, Xu Q, Yan F, et al. Comparison of 7 Surgical Interventions for Lumbar Disc Herniation:A Network Meta-analysis[J]. Pain Physician, 2017, 20(6):E863
[10] Deng Q, Junjie L I, Zhang Y, et al. Clinical Observation on the Treatment of Thoracic and Lumbar Vertebral Tuberculosis with Incomplete Paralysis Based on the Theory of Du Meridian[J]. Chinese Journal of Traditional Medical Traumatology&Orthopedics, 2018,(2):23-27
[11] Ikuta K, Tarukado K, Masuda K. Characterization and Risk Factor Analysis for Recurrence Following Microendoscopic Diskectomy for Lumbar Disk Herniation[J]. J Neurol Surg A Cent Eur Neurosurg,2017, 78(02):154-160
[12] Zoia C, Bongetta D, Poli J C, et al. Intraregional differences of perioperative management strategy for lumbar disc herniation:is the Devil really in the details?[J]. International Journal of Spine Surgery,2017, 11(1):1
[13] Moon S H, Lee J I, Cho H S, et al. Factors for Predicting Favorable Outcome of Percutaneous Epidural Adhesiolysis for Lumbar Disc Herniation[J]. Pain Research&Management, 2017, 2017(9):1-10
[14] Eun S S, Eum J H, Lee S H, et al. Biportal Endoscopic Lumbar Decompression for Lumbar Disk Herniation and Spinal Canal Stenosis:A Technical Note[J]. J Neurol Surg A Cent Eur Neurosurg,2017, 78(04):390-396
[15] Sadeghian H, Motieilangroudi R. Pitting Oedema in a Patient with Lumbar Disc Herniation:Case report of an unusual association[J].Sultan Qaboos University Medical Journal, 2017, 17(4):e464
[16] Xie T H, Zeng J C, Li Z H, et al. Complications of Lumbar Disc Herniation Following Full-endoscopic Interlaminar Lumbar Discectomy:A Large, Single-Center, Retrospective Study[J]. Pain Physician, 2017, 20(3):E379
[17] Hai-Hao W U, Tang T, Pang Q J, et al. Percutaneous endoscopic lumbar discectomy combined with epidural injection for prolapsed lumbar disc herniation[J]. China Journal of Orthopaedics&Traumatology, 2017, 30(2):110-114
[18] Chen B L, Guo J B, Zhang H W, et al. Surgical versus non-operative treatment for lumbar disc herniation:a systematic review and metaanalysis[J]. Clinical Rehabilitation, 2018, 32(2):269215517719 952
[19] Dat W, Grotle M, Gulati S, et al. Criteria for failure and worsening after surgery for lumbar disc herniation:a multicenter observational study based on data from the Norwegian Registry for Spine Surgery.[J]. European spine journal:official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2017, 26(Suppl 3):1-10
[20] Zhang Y, Yin Q, Zhu M, et al. Collagenase chemonucleolysis versus percutaneous endoscopic discectomy for extraforaminal lumbar disc herniations[J]. International Journal of Clinical&Experimental Medicine, 2017, 10(5):8610-8619
[21] Karademir M, Eser O, Karavelioglu E. Adolescent lumbar disc herniation:Impact, diagnosis, and treatment[J]. Journal of Back&Musculoskeletal Rehabilitation, 2017, 30(2):347
[22] Fei H, Li W S, Sun Z R, et al. Analysis of Spino-pelvic Sagittal Alignment in Young Chinese Patients with Lumbar Disc Herniation[J]. Orthop Surg, 2017, 9(3):271-276
[23] Zhao J, Zhang H, Zhao S, et al. The Effects of DuZhong YaoTong Pills Combined with XiaoDing Ointment on Low Back Pain after the Surgery of LDH[J]. Western Journal of Traditional Chinese Medicine,2017, 30(11):1-4
[24] Guo Z, Hongchao Y U, Shi D, et al. Curative effect of massage,acupuncture with traction-reduction on prolapse of lumbar intervertebral disc and on serum IL-1βand TNF-αin the patients[J].Modern Journal of Integrated Traditional Chinese&Western Medicine, 2017, 26(19):2064-2066
[25] Wang F,Wang K, Xu W, et al. SIRT5 Desuccinylates and Activates Pyruvate Kinase M2 to Block Macrophage IL-1βProduction and to Prevent DSS-Induced Colitis in Mice[J]. Cell Reports, 2017, 19(11):2331-2344
[26] Weichand B, Popp R, Dziumbla S, et al. S1PR1 on tumor-associated macrophages promotes lymphangiogenesis and metastasis via NLRP3/IL-1β[J]. Journal of Experimental Medicine, 2017, 214(9):2695-2713
[27] Martínsánchez F, Martínezgarcía J J, Mu觡ozgarcía M, et al. Lytic cell death induced by melittin bypasses pyroptosis but induces NLRP3 inflammasome activation and IL-1βrelease[J]. Cell Death&Disease, 2017, 8(8):e2984
[28] Wang F, Jiang Y, Huang X, et al. Pro-Inflammatory Cytokine TNF-αAttenuates BMP9-Induced Osteo/Odontoblastic Differentiation of the Stem Cells of Dental Apical Papilla(SCAPs)[J]. Cellular Physiology&Biochemistry International Journal of Experimental Cellular Physiology Biochemistry&Pharmacology, 2017, 41(5):1725
[29] Wu G R, Mu T C, Gao Z X, et al. Prion protein is required for tumor necrosis factor alpha(TNFα)-triggered nuclear factor kappa B(NF-κB)signaling and cytokine production[J]. Journal of Biological Chemistry, 2017, 292(46):18747-18759
[30] Hartley G, Regan D, Guth A, et al. Regulation of PD-L1 expression on murine tumor-associated monocytes and macrophages by locally produced TNF-α[J]. Cancer Immunology Immunotherapy, 2017, 66(4):523-535