经皮内窥镜椎间盘切除术治疗腰椎间盘突出症术后复发的影响因素分析  

Analysis of influencing factors on postoperative recurrence of lumbar disc herniation treated with percutaneous endoscopic lumbar discectomy

作　　者：李罡 金莲锦 国慧颖 张鑫悦 胡昊 LI Gang;JIN Lianjin;GUO Huiying;ZHANG Xinyue;HU Hao(Department of Orthopedics,Red Flag Hospital Affiliated to Mudanjiang Medical College,Heilongjiang Province,Mudanjiang157011,China;Department of Anesthesiology,Red Flag Hospital Affiliated to Mudanjiang Medical College,Heilongjiang Province,Mudanjiang157011,China;The First Clinical Medical College,Mudanjiang Medical College,Heilongjiang Province,Mudanjiang157011,China)

机构地区：[1]牡丹江医学院附属红旗医院骨外科,黑龙江牡丹江157011 [2]牡丹江医学院附属红旗医院麻醉科,黑龙江牡丹江157011 [3]牡丹江医学院第一临床医学院,黑龙江牡丹江157011

出　　处：《中国当代医药》2024年第20期52-55,64,共5页China Modern Medicine

基　　金：黑龙江省省属高校基本科研业务费科研项目(2021-KYYWF-0495)。

摘　　要：目的通过对经皮内窥镜椎间盘切除术(PELD)治疗腰椎间盘突出症(LDH)的术后复发病例进行回顾性研究,探讨其临床疗效,并分析可能导致术后复发的危险因素。方法对在牡丹江医学院附属红旗医院自2021年1月1日起至2022年12月31日就诊的腰椎间盘突出症患者进行回顾性分析。该研究共纳入160例患者。记录患者的年龄,性别,体重指数,吸烟史,高血脂,高血压,饮酒情况,有无糖尿病史,腰椎间盘突出的种类。随访完成后,统计复发率。采用单因素及多因素logistic回归分析,探讨手术后复发的影响因素。结果160例患者中有19例出现了复发,复发率为11.88%单变量分析结果显示,LDH患者经PELD治疗后的复发率与高脂血症、性别、饮酒和高血压无关,差异无统计学意义(P>0.05),但与年龄、体重指数、突出类型、糖尿病及吸烟有关,差异有统计学意义(P<0.05);多因素logistic回归模型进行多因素分析结果显示,体重指数(β=3.534,OR=15.362,95%CI=2.631~112.456)、年龄(β=2.189,OR=8.926,95%CI=1.707~46.675)、突出类型(β=2.163,OR=8.706,95%CI=1.034~73.284)、糖尿病(β=1.928,OR=6.876,95%CI=1.544~30.613)、吸烟(β=2.624,OR=13.778,95%CI=2.918~65.060)是接受PELD治疗的LDH患者复发的独立危险因素(P<0.05)。结论年龄较大、体重指数较高、突出类型、合并糖尿病以及吸烟的患者在接受PELD治疗后复发的风险较高,临床上早期有针对性的干预措施可减少术后复发。Objective To investigate the clinical effect of percutaneous endoscopic lumbar discectomy(PELD)on postoperative recurrence of lumbar intervertebral disc herniation(LDH).Methods A retrospective analysis was conducted on LDH patients who visited Red Flag Hospital Affiliated to Mudanjiang Medical College from January 1,2021 to December 31,2022.A total of 160 patients were included in Red Flag Hospital Affiliated to Mudanjiang Medical College.The age,sex,body mass index,smoking history,hyperlipidemia,hypertension,alcohol consumption,diabetes history and types of lumbar disc herniation were recorded.After the follow-up was completed,the recurrence rate was calculated.Univariate and multivariate logistic regression analysis were used to explore the influencing factors of postoperative recurrence.Results Among 160 patients,19 patients recurred,and the recurrence rate was 11.88%.Univariate analysis showed that the recurrence rate of LDH patients after PELD treatment was not related to gender,hyperlipidemia,hypertension and alcohol consumption,and the differences were not statistically significant(P>0.05),but related to age,body mass index,prominent type,diabetes and smoking,and the differences were statistically significant(P<0.05).Multivariate logistic regression model showed that body mass index(β=3.534,OR=15.362,95%CI=2.631-112.456),age(β=2.189,OR=8.926,95%CI=1.707-46.675),prominent type(β=2.163,OR=8.706,95%CI=1.034-73.284),diabetes(β=1.928,OR=6.876,95%CI=1.544-30.613),smoking(β=2.624,OR=13.778,95%CI=2.918-65.060)were independent risk factors for recurrence of LDH in patients receiving PELD treatment(P<0.05).Conclusion Patients with older age,higher BMI,prominent type,diabetes and smoking are at higher risk of recurrence after PELD treatment.Targeted intervention measures can be taken early to reduce postoperative recurrence.

关 键 词：经皮内窥镜 腰椎间盘突出症 复发性腰椎间盘突出 影响因素 多因素LOGISTIC回归分析 

分 类 号：R681[医药卫生—骨科学]