经皮椎间孔镜治疗腰椎间盘突出症术后复发的影响因素分析  

Clinical Study on Influencing Factors of Recurrence of Lumbar Disc Herniation After Percutaneous Transforaminal Endoscopy

作　　者：何航 徐峰 马俊 熊承杰 魏坦军 唐傲林 陈永康 HE Hang;XU Feng;MA Jun;XIONG Chengjie;WEI Tanjun;TANG Aolin;CHEN Yongkang(School of Medical,Wuhan University of Science and Technology,Wuhan Hubei 430070,China)

机构地区：[1]武汉科技大学医学院,湖北武汉430070 [2]中部战区总医院骨科

出　　处：《联勤军事医学》2023年第1期38-42,47,共6页Military Medicine of Joint Logistics

基　　金：武汉市科技计划项目(2019020701011423)。

摘　　要：目的探讨腰椎间盘突出症(lumbar disc herniation,LDH)经皮椎间孔镜腰椎间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)后复发的发生率及其复发的影响因素。方法回顾性分析2015-01/2021-04月因LDH于作者医院就诊行PELD的690例患者的临床资料。记录患者的年龄、性别、体质量指数(body mass index,BMI)、吸烟史、糖尿病病史、手术时间、椎间盘突出类型、椎间盘突出位置分区、有无椎间盘高信号改变(high-intensity zones,HIZ)、有无Modic变化、椎间盘退变Pfirrmann分级、椎间盘高度指数(disc height index,DHI)、椎间活动度(sagittal range of motion,sROM)及髂嵴高度分级等指标。随访后记录患者的复发时间、术后复发率。采用单因素及多因素Logistic回归分析探讨术后复发的影响因素。结果690例患者术后复发46例,复发率6.67%。单因素分析结果显示,复发组与未复发组在年龄≥43岁,BMI≥23.10 kg/m2,椎间盘突出位置分区,有Modic变化,椎间盘退变Pfirrmann分级及sROM≥7°差异有统计学意义(P均<0.05)。Logistic回归分析结果显示,年龄≥43岁(OR=2.529)、BMI≥23.10 kg/m2(OR=3.779)、突出位置分区(2ab,3a,3b,3ab)(OR=1.962)、有Modic改变(OR=6.940)及sROM≥7°(OR=2.219)是术后复发的影响因素。结论年龄≥43岁、BMI≥23.10 kg/m2、突出位置分区(2ab,3a,3b,3ab)、有Modic改变以及sROM≥7°是LDH患者PELD后复发的影响因素。Objective To investigate the incidence of postoperative recurrence of lumbar disc herniation(LDH)treated by percutaneous endoscopic lumbar discectomy(PELD)and to analyze its influencing factors.Methods Clinical data of 690 patients who underwent PELD for LDH in author′s hospital from January 2015 to April 2021 was retrospectively analyzed,and the age,gender,body mass index(BMI),smoking history,diabetes history,operation time,type of disc herniation,location of disc herniation,presence or absence of intervertebral disc high-intensity zones(HIZ),whether Modic changed,intervertebral disc degeneration Pfirrmann grade,disc height index(DHI),sagittal range of motion(sROM)and iliac Crisis height grading and other indicators.The recurrence time and the postoperative recurrence rate of patients was recorded after follow-up.Univariate and multivariate Logistic regression analysis were used to evaluate the influencing factors of postoperative recurrence.Results A total of 46 cases of 690 patients recurred after operation,the recurrence rate was 6.67%.The results of univariate analysis showed that the recurrence group and the non-recurrence group were age≥43 years old,BMI≥23.10 kg/m~2,location of disc herniation,Modic changed,Pfirrmann grade of intervertebral disc degeneration and sROM≥7°,and the difference was statistically significant(all P<0.05).The results of Logistic regression analysis showed that age≥43 years old(OR=2.529),BMI≥23.10 kg/m~2(OR=3.779),location of disc herniation(2ab,3a,3b,3ab)(OR=1.962),Modic changed(OR=6.940)and sROM≥7°(OR=2.219)were the influencing factors of postoperative recurrence.Conclusion Age≥43 years old,BMI≥23.10 kg/m~2,disc herniation location(2ab,3a,3b,3ab),Modic changed and sROM≥7°are the influencing factors for recurrence after PELD in LDH patients.

关 键 词：经皮椎间孔镜 腰椎间盘突出症 复发性腰椎间盘突出 影响因素 LOGISTIC回归分析 

分 类 号：R687.3[医药卫生—骨科学]