经皮脊柱内镜下腰椎间盘切除术后早期和中期不良预后的风险因素  

Risk factors for poor prognosis in the early and mid-term after percutaneous endoscopic lumbar discectomy

作　　者：张立冬[1] 裴志超 马彦飞 李攀 ZHANG Li-dong;PEI Zhi-chao;MA Yan-fei;LI Pan(Pain Department,Henan Hongli Hospital,Xinxiang,Henan 453000,China;Orthopedics,Henan Hongli Hospital,Xinxiang,Henan 453000,China;Traditional Chinese Medicine Orthopedics Department,Xinxiang,Henan 453000,China)

机构地区：[1]河南宏力医院疼痛科,河南新乡453000 [2]河南宏力医院骨科,河南新乡453000 [3]河南宏力医院中医骨伤科,河南新乡453000

出　　处：《颈腰痛杂志》2024年第5期919-924,共6页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的观察经皮脊柱内镜下腰椎间盘切除术(Percutaneous endoscopic lumbar discectomy,PELD)治疗腰椎间盘突出症(lumbar disc herniation,LDH)术后早期和中期不良预后的发生情况,并分析其风险因素。方法以该院2018年1月~2021年9月期间开展PELD手术的140例LDH患者作为研究对象,术后6个月和24个月随访时,采用改良MacNab标准评估临床结局,以疗效为“优”+“良”的患者列入预后良好组,以疗效为“可”+“差”的患者列入预后不良组。对两组患者的临床资料、术前相关影像学参数等资料单因素分析,并进一步采用多因素Logistic回归模型进行分析,得出具有独立相关性的影响因素。结果术后6个月时,预后良好者121例,预后不良者19例;多因素Logistic回归分析得出:sROM(OR=1.159,P=0.023)、症状持续时间(OR=1.12795%,P=0.004)、直腿抬高角度(OR=1.103,P=0.039),均是PELD术后6个月预后不良的独立风险因素。术后24个月时,预后良好者115例,预后不良者25例;多因素Logistic回归分析得出:sROM(OR=1.290,P=0.009)、症状持续时间(OR=1.036,P=0.021),均是PELD术后24个月预后不良的独立风险因素,IHI(OR=0.812,P=0.014)则是一项保护因素。结论PELD手术治疗LDH的总体疗效理想,但术后早期和中期仍有少数患者面临预后不良的结局。其中,直腿抬高角度是PELD术后早期预后不良的独立风险因素,IHI是术后中期预后不良的独立保护因素;而sROM、症状持续时间则是术后早期和中期的共同风险因素。Objective To observe the occurrence of early and mid-term adverse prognosis of percutaneous endoscopic lumbar discectomy(PELD)in the treatment of lumbar disc herniation(LDH)and analyze its risk factors.Methods A total of 140 patients with lumbar disc herniation(LDH)who underwent percutaneous endoscopic lumbar discectomy(PELD)in our hospital from January 2018 to September 2021 were enrolled as the study subjects.At the 6-month and 24-month follow-ups after surgery,clinical outcomes were assessed using the modified MacNab criteria.Patients with"excellent"or"good"outcomes were classified into the good prognosis group,while those with"fair"or"poor"outcomes were classified into the poor prognosis group.The clinical data and preoperative imaging parameters of the two groups were analyzed using univariate analysis,followed by multivariate logistic regression analysis to identify independently associated factors.Results At the 6-month follow-up,121 patients had a good prognosis,and 19 had a poor prognosis.Multivariate logistic regression analysis revealed that sROM(OR=1.159,P=0.023),duration of symptoms(OR=1.12795%,P=0.004),and straight leg raising angle(OR=1.103,P=0.039)were independent risk factors for poor prognosis at 6 months after PELD.At the 24-month follow-up,115 patients had a good prognosis while 25 had a poor prognosis.Multivariate logistic regression analysis showed that sROM(OR=1.290,P=0.009)and duration of symptoms(OR=1.036,P=0.021)were independent risk factors for poor prognosis at 24 months after PELD,while IHI(OR=0.812,P=0.014)was a protective factor.Conclusion The overall effect of PELD surgery in the treatment of LDH is ideal,but early and mid-term postoperative patients still face adverse outcomes in a small number of cases.Among them,straight leg raising angle is an independent risk factor for early adverse prognosis after PELD surgery,while IHI is an independent protective factor for mid-term adverse prognosis after surgery;sROM and duration of symptoms are common risk factors for early and mid-term

关 键 词：腰椎间盘突出症 脊柱内镜 预后不良 中期疗效 早期疗效 风险因素 

分 类 号：R687.3[医药卫生—骨科学]