朱峻松+沈玉杰+王宇

[摘要] 目的 探讨后路管状位穿刺靶点法射频热凝治疗腰椎间盘突出症的临床效果及作用机制。 方法 选取武汉市普仁医院疼痛科2012年6月～2013年12月收治的腰椎间盘突出症患者180例，随机分为两组，每组各90例。治疗组采用后路管状位穿刺靶点法射频热凝靶点治疗，对照组采用臭氧注射治疗。采用改良Macnab评估临床疗效；肿瘤坏死因子α（TNF-α）和白介素-1β（IL-1β）检测采用酶联免疫法测定。观察两组治疗前后临床疗效及外周血中TNF-α和IL-1β的变化。 结果 术后1周、1个月及3个月时进行疗效评估，治疗组优良率分别为85.6%（77/90）、90.0%（81/90）及92.2%（83/90），均高于同时期对照组72.2%（65/90）、78.9%（71/90）及68.9%（62/90），差异有统计学意义（P < 0.05）。治疗后两组患者血中TNF-α和IL-1β含量均较治疗前显著减低（P < 0.01），治疗组治疗后TNF-α[（17.15±2.27）ng/mL]、IL-1β[（9.39±1.03）pg/mL]含量显著低于对照组[（29.62±3.36）ng/mL、（14.59±2.23）pg/mL]，差异有统计学意义（P < 0.05）。 结论 后路管状位穿刺靶点法射频热凝治疗腰椎间盘突出症安全高效，远期效果显著，并对外周血中TNF-α和IL-1β含量有明显的良性调节作用，这可能是射频热凝靶点治疗腰椎间盘突出症的作用机制之一。

[关键词] 管状位；腰椎间盘突出症；射频热凝；靶点；肿瘤坏死因子α；白介素-1β

[中图分类号] R681.55 [文献标识码] A [文章编号] 1673-7210（2016）10（c）-0087-04

[Abstract] Objective To investigate the clinical effect and mechanism of target ablation with radiofrequency thermocoagulation by posterior approach of tubular position in the treatment of lumbar disc herniation. Methods 180 cases of patients with lumbar disc herniation in Department of Pain Management， Wuhan Puren Hospital， from June 2012 to December 2013 were selected and randomly divided into two groups， 90 cases in each group. The treatment group was treated with radiofrequency thermocoagulation by posterior approach of tubular position. The control group was treated with ozone injection therapy. Clinical efficacy was assessed using modified Macnab. TNF-α and IL-1β were determined by enzyme-linked immunosorbent assay. The clinical efficacy and changes of TNF-α and IL-1β levels before and after treatment were observed. Results 1 week， 1 month and 3 month after surgery， the excellent and good rates of the treatment group were 85.6% （77/90）， 90.0% （81/90） and 92.2% （83/90） respectively， which were higher than those of the control group [72.2% （65/90）， 78.9% （71/90）， 68.9% （62/90）] at the same time， the differences were statistically significant （P < 0.05）. After treatment， in the two groups the serum TNF-α and IL-1β levels were significantly lower than before treatment （P < 0.01）. After treatment， TNF-α [（17.15±2.27） ng/mL] and IL-1β [（9.39±1.03） pg/mL] levels of the treatment group were significantly lower than those of the control group [（29.62±3.36） ng/mL， （14.59±2.23） pg/mL]， the differences were statistically significant （P < 0.05）. Conclusion There are benign regulation effects and good efficacy of target ablation with radiofrequency thermocoagulation by posterior approach of tubular position on the TNF-α and IL-1β levels in peripheral blood of patients with lumbar disc herniation. This may be one of the mechanisms for the treatment of lumbar disc herniation by radiofrequency thermocoagulation.

[Key words] Tubular position； Lumbar disc herniation； Radiofrequency thermocoagulation； Target； TNF-α； IL-1β

腰椎间盘突出症（LDH）是一种常见病、多发病，其出现腰痛和下肢神经根性痛发病机制尚未十分清楚。有学者认为局部有炎症刺激和免疫反应是LDH引起根性痛的主要原因之一[1]。武汉市普仁医院疼痛科（以下简称“我科”）采用自拟后路管状位穿刺靶点法射频热凝治疗LDH，取得显著疗效。为了探讨其作用机制，本研究同步观察LDH患者治疗前后外周血中肿瘤坏死因子α（TNF-α）和白介素-1（IL-1β）的变化，现报道如下：

1 资料与方法

1.1 一般资料

选择2012年6月～2013年12月我科住院的LDH患者180例，其中L4～5椎间盘突出91例，L5～S1 78例，L4～5合并L5～S1 11例。按患者就诊顺序编号，采用随机数字表法分为两组，各90例。治疗组，男56例，女34例；年龄27～80岁，平均（46.16±11.72）岁；病程2周～3年，平均（4.60±2.76）个月。对照组，男61例，女29例；……