经皮椎间孔镜治疗腰椎间盘突出症术后复发影响因素研究  

A study on the risk factors of recurrence after percutaneous endoscopic lumbar discectomy

作　　者：梁智林 海涌[1] 杨晋才[1] 张耀申 张扬璞 潘爱星 尹鹏 李冬月[1] LIANG Zhi-lin;HAI Yong;YANG Jin-cai;ZHANG Yao-shen;ZHANG Yang-pu;PAN Ai-xing;YIN Peng;LI Dong-yue(Department of Orthopaedics,Beijing Chaoyang Hospital,Capital Medical University,Beijing,100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科

出　　处：《中国骨与关节杂志》2020年第1期5-10,共6页Chinese Journal of Bone and Joint

摘　　要：目的分析经皮椎间孔镜髓核摘除术治疗腰椎间盘突出症复发的危险因素。方法纳入自 2014 年 1 月至 2017 年 12 月,在我院接受椎间孔镜髓核摘除术治疗的腰椎间盘突出症患者 168 例,其中男99 例,女 69 例;平均年龄 (42.51±14.83) 岁。术前对患者的一般情况 (性别、年龄、身高、体重等)、糖尿病病史、高血压病史、饮酒史、吸烟史、腰椎间盘突出类型等进行采集,术后对其复发状况进行随访观察,并分别于术前、术后即刻和术后 6 个月采用疼痛视觉模拟评分 (visual analogue scale,VAS) 来评价患者的疼痛程度。采用 Cox 比例风险模型来分析术后复发的危险因素。结果本组 168 例中,术后复发 17 例,复发率 10.12%。单因素分析显示在复发组和非复发组之间,体质量指数 (body mass index,BMI) ≥ 24 (HR=5.11,95% CI:1.17~22.37),糖尿病 (HR=2.91,95% CI:1.08~7.84) 是腰椎间盘突出症术后复发 (postoperative recurrent lumbar disc herniation,PRLDH) 的危险因素,腰椎间盘脱出 (HR=0.31,95% CI:0.10~0.95) 是 PRLDH 的保护因素。多因素分析显示,吸烟 (HR=2.86,95% CI:1.03~7.99),高 BMI (HR=4.51,95% CI:1.02~19.90),糖尿病 (HR=3.06,95% CI:1.13~8.28) 是 PRLDH 的危险因素,而腰椎间盘脱出 (HR=0.32,95% CI:0.10~0.98) 是 PRLDH 保护因素。结论吸烟、高 BMI、糖尿病是 PRLDH 发生的危险因素,腰椎间盘脱出是 PRLDH 发生的保护因素。Objective To analyze the risk factors of recurrence after percutaneous endoscopic lumbar discectomy (PELD).Methods A total of 168 patients after PELD were enrolled in this study from January 2014 to December 2017,including 99 males and 69 females.The average age was (42.51±14.83) years.Basic information (gender,age,height,weight),diabetes,hypertension,drinking,smoking and type of lumber disc herniation were collected before operation.Postoperative recurrent lumbar disc herniation (PRLDH) was observed in the follow-up.Visual analogue score (VAS) was used to evaluate the pain before surgery,immediately after surgery,and 6 months after surgery.Cox proportional hazards model was used to analyze risk factors of recurrence after PELD.Results Recurrence occurred in 17 patients with a postoperative recurrence rate of 10.12% (17/168).Univariate analysis showed that BMI ≥ 24 (HR=5.11,95% CI:1.17-22.37) and diabetes (HR=2.91,95% CI:1.08-7.84) were risk factors of PRLDH,while disc protrusion (HR=0.31,95% CI:0.10-0.95) was a protective factor between the recurrent and non-recurrent group.Multivariate analysis indicated smoking (HR=2.86,95% CI:1.03-7.99),high BMI (HR=4.51,95% CI:1.02-19.90),and diabetes (HR=3.06,95% CI:1.13-8.28) were risk factors of PRLDH,while disc protrusion (HR=0.32,95% CI:0.10-0.98) was a protective factor between the recurrent and non-recurrent group.Conclusions Smoking,high BMI,and diabetes are risk factors of PRLDH,while disc protrusion is a protective factor.

关 键 词：最小侵入性外科手术 复发 多因素分析 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]