经椎间孔椎体间融合术（TLIF）后对侧早期神经根性疼痛的危险因素分析

doi:10.3877/cma.j.issn.2096-0263.2023.05.003

中华老年骨科与康复电子杂志 ›› 2023, Vol. 09 ›› Issue (05) : 269 -274. doi: 10.3877/cma.j.issn.2096-0263.2023.05.003

脊柱专题

经椎间孔椎体间融合术（TLIF）后对侧早期神经根性疼痛的危险因素分析

李子彤, 李林斌, 马涛, 高共鸣, 农鲁明^†(

)

116044　南京医科大学常州医学中心，南京医科大学附属常州市第二人民医院脊柱外科

收稿日期:2023-01-31 出版日期:2023-10-05
通信作者: 农鲁明
基金资助:
江苏省卫生健康委医学科研立项项目(H2019025); 江苏省重点研发计划（社会发展）(BE2020650); 江苏省"六大人才高峰"高层次人才选拔培养资助计划(WSW-186); 常州市科技计划（国际科技合作/港澳台科技合作）项目(CZ20200037); 常州市高层次卫生人才培养工程(2022CZLJ016); 南京医科大学常州医学中心项目(CMCM202209)

Correlation analysis of early contralateral nerve root pain and inflammatory factors after transforaminal interbody fusion (TLIF)

Zitong Li, Linbin Li, Tao Ma, Gongming Gao, Luming Nong^†()

Department of Spinal Surgery, The Second People's Hospital of Changzhou, Changzhou Medical Center, Nanjing Medical University, Changzhou 116044, China

Received:2023-01-31 Published:2023-10-05
Corresponding author: Luming Nong

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引用本文：

李子彤, 李林斌, 马涛, 高共鸣, 农鲁明. 经椎间孔椎体间融合术（TLIF）后对侧早期神经根性疼痛的危险因素分析[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 269-274.

Zitong Li, Linbin Li, Tao Ma, Gongming Gao, Luming Nong. Correlation analysis of early contralateral nerve root pain and inflammatory factors after transforaminal interbody fusion (TLIF)[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2023, 09(05): 269-274.

目的

确定经椎间孔椎体间融合术（TLIF）术后患者常伴有健侧神经根性疼痛术后早期对侧神经根性疼痛的主要危险因素。

方法

回顾性收集2020年1月至2022年1月期间在南京医科大学附属常州市第二人民医院城中院区脊柱外科行TLIF手术的170名患者，根据其是否发生术后早期对侧神经根性疼痛，将其分为无症状组与症状组。其中66例患者符合纳入排除标准，33例患者发生术后早期健侧神经根性疼痛。对两组患者术后进行随访，收集患者的一般资料及手术相关指标，术后3 d伤口引流液中炎症因子的浓度，进行组间比较和回归分析。

结果

最终纳入66例患者作为研究对象，随访时间（26.6±1.1）d。男36例，女30例，平均年龄（66±8）岁。单因素分析显示：相较于无症状组，症状组患者引流液中的PGE2浓度降低（P<0.01）；引流液中HIS、BK浓度均高于无症状组（P<0.01），其余指标组间比较差异无统计学意义（P>0.05）。将单因素分析中组间有差异的指标纳入多因素回归分析，结果显示，引流液中HIS（OR=4.384）和BK（OR=10.921）是TLIF术后对侧早期神经根性疼痛的影响因素。

结论

TLIF术后患者引流液中HIS、BK水平是发生对侧早期神经根性疼痛的独立危险因素，可作为管理发生术后早期对侧神经根性疼痛患者的参考依据，为临床上治疗该类患者提供新思路。

关键词: 腰椎融合术, 对侧神经根病, 前列腺素2, 组胺缓激肽, 5-羟色胺

Objective

To determine the main risk factors for early postoperative contralateral radicular pain in patients after transforaminal interbody fusion (TLIF) who often suffer from contralateral radicular pain.

Methods

Patients who underwent TLIF surgery in the Department of Spinal surgery of Changzhou second people's Hospital affiliated to Nanjing Medical University were collected and divided into asymptomatic group and symptomatic group according to whether they had early contralateral nerve root pain after operation. A total of 170 patients underwent TLIF surgery in our department from January 2020 to January 2022, of which 66 patients met the inclusion and exclusion criteria and 33 patients developed early postoperative contralateral nerve root pain. The patients of the two groups were followed up after operation, the general data and operation-related indexes were collected, and the concentration of inflammatory factors in wound drainage fluid 3 days after operation were compared and analyzed by regression analysis.

Results

Finally, 66 patients were included in the study, and the follow-up time was (26.6±1.1) days. There were 36 males and 30 females with an average age of (66±8) years. Univariate analysis showed that the concentration of PGE2 in drainage fluid in symptom group was lower than that in asymptomatic group, and the concentrations of HIS and BK in drainage fluid in symptom group were higher than those in asymptomatic group. The differences between groups in univariate analysis were included in multivariate regression analysis. The results showed that HIS (OR=4.384) and BK (OR=10.921) in drainage fluid were the influencing factors of contralateral early nerve root pain after TLIF.

Conclusion

The levels of HIS and BK in the drainage fluid of patients after TLIF are independent risk factors for the occurrence of contralateral early nerve root pain, which can be used as a reference basis for managing patients with early contralateral nerve root pain after operation, and provide new ideas for clinical treatment of this kind of patients.

Key words: Lumbar fusion, Contralateral radiculopathy, Prostaglandin 2, Histamine, Bradykinin, Serotonin

图3~4 患者，男，67岁，腰椎滑脱腰椎侧位X线片示症状组患者接受TLIF前后变化

表1 两组行TLIF治疗的腰椎退行性病变患者基本情况组间比较

组别	例数	性别（例，男/女）	年龄（岁，±s）	BMI（kg/m²，±s）	病种（例）
组别	例数	性别（例，男/女）	年龄（岁，±s）	BMI（kg/m²，±s）	腰椎间盘突出	腰椎管狭窄	腰椎滑脱
无症状组	33	19/14	65.20±6.50	21.39±3.43	4	13	16
症状组	33	17/16	66.98±9.46	22.69±4.44	3	15	15
统计值		χ²=0.244	t=0.6760	t=1.009	χ²=0.392
P值		0.621	0.50	0.32	0.883

表1 两组行TLIF治疗的腰椎退行性病变患者基本情况组间比较

组别	例数	性别（例，男/女）	年龄（岁，±s）	BMI（kg/m²，±s）	病种（例）
组别	例数	性别（例，男/女）	年龄（岁，±s）	BMI（kg/m²，±s）	腰椎间盘突出	腰椎管狭窄	腰椎滑脱
无症状组	33	19/14	65.20±6.50	21.39±3.43	4	13	16
症状组	33	17/16	66.98±9.46	22.69±4.44	3	15	15
统计值		χ²=0.244	t=0.6760	t=1.009	χ²=0.392
P值		0.621	0.50	0.32	0.883

表2 两组行TLIF治疗的腰椎退行性病变患者临床指标组间比较结果（±s）

组别	例数	病程（d）	融合节段数	手术持续时间（min）	术中出血量（mL）	术后引流量（mL）
无症状组	33	2.36±0.83	1.74±0.85	125.72±43.36	258.74±129.17	41.78±18.79
症状组	33	1.93±0.86	1.79±0.83	128.54±47.53	254.62±131.59	38.52±19.33
t值		1.568	0.1835	0.1911	0.09739	0.5271
P值		0.13	0.86	0.85	0.92	0.60

表2 两组行TLIF治疗的腰椎退行性病变患者临床指标组间比较结果（±s）

组别	例数	病程（d）	融合节段数	手术持续时间（min）	术中出血量（mL）	术后引流量（mL）
无症状组	33	2.36±0.83	1.74±0.85	125.72±43.36	258.74±129.17	41.78±18.79
症状组	33	1.93±0.86	1.79±0.83	128.54±47.53	254.62±131.59	38.52±19.33
t值		1.568	0.1835	0.1911	0.09739	0.5271
P值		0.13	0.86	0.85	0.92	0.60

表3 两组行TLIF治疗的腰椎退行性病变患者术后第3天炎症指标组间比较结果（±s）

组别	例数	PGE2	HIS	BK	5-HT
无症状组	33	174.04±39.52	7.56±0.94	2.70±0.61	321.07±91.70
症状组	33	140.49±41.92	8.94±1.41	3.38±0.63	299.15±51.55
t值		2.538	-3.564	-3.368	0.908
P值		0.016	0.001	0.002	0.370

表3 两组行TLIF治疗的腰椎退行性病变患者术后第3天炎症指标组间比较结果（±s）

组别	例数	PGE2	HIS	BK	5-HT
无症状组	33	174.04±39.52	7.56±0.94	2.70±0.61	321.07±91.70
症状组	33	140.49±41.92	8.94±1.41	3.38±0.63	299.15±51.55
t值		2.538	-3.564	-3.368	0.908
P值		0.016	0.001	0.002	0.370

表4 行TLIF治疗的腰椎退行性病变患者术后发生对侧早期神经根性疼痛的多因素分析

指标	B	标准误	P	OR	95% CI
HIS	1.478	0.569	0.009	4.384	（1.437，13.379）
BK	2.391	0.912	0.009	10.921	（1.828，65.235）
PGE	-0.013	0.011	0.251	0.987	（0.965，1.009）
HT	-0.007	0.006	0.255	0.993	（0.982，1.005）

表4 行TLIF治疗的腰椎退行性病变患者术后发生对侧早期神经根性疼痛的多因素分析

指标	B	标准误	P	OR	95% CI
HIS	1.478	0.569	0.009	4.384	（1.437，13.379）
BK	2.391	0.912	0.009	10.921	（1.828，65.235）
PGE	-0.013	0.011	0.251	0.987	（0.965，1.009）
HT	-0.007	0.006	0.255	0.993	（0.982，1.005）

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