腰椎椎间盘突出症后发生钙化的影响因素及其对术式选择和预后的影响  

Influencing factors of calcification after lumbar disc herniation and its impact on surgical selection and prognosis

作　　者：刘雪洋 李馨 米如文 刁鹏飞 孙灰灰 Liu Xueyang;Li Xin;Mi Ruwen;Diao Pengfei;Sun Huihui(Department of Spinal Surgery,Northern Jiangsu People's Hospital Affiliated to Yangzhou University,Yangzhou 225001,Jiangsu,China;Department of Pharmacy,Northern Jiangsu People's Hospital Affiliated to Yangzhou University,Yangzhou 225001,Jiangsu,China;Clinical Medicine School,Yangzhou University,Yangzhou 225009,Jiangsu,China;Department of Orthopaedics,Third People's Hospital of Yangzhou,Yangzhou 225125,Jiangsu,China)

机构地区：[1]扬州大学附属苏北人民医院脊柱外科,扬州225001 [2]扬州大学附属苏北人民医院药学部,扬州225001 [3]扬州大学医学院,扬州225009 [4]扬州市第三人民医院骨科,扬州225125

出　　处：《脊柱外科杂志》2025年第2期82-87,共6页Journal of Spinal Surgery

基　　金：江苏省自然科学基金青年基金项目(BK20230294);扬州市自然科学基金(YZ2023166)。

摘　　要：目的探讨腰椎椎间盘突出症(LDH)后发生椎间盘钙化的影响因素及其对术式选择和预后的影响。方法回顾性分析扬州大学附属苏北人民医院2019年1月—2022年8月收治的420例LDH患者临床资料,根据突出椎间盘是否钙化分为钙化组(n=157)和非钙化组(n=263)。比较2组年龄、性别、体质量指数(BMI)、病程、合并基础疾病(高血压和/或糖尿病)、椎间盘退行性变Pfirrmann分级、LDH节段、LDH类型、MRI上椎间盘突出组织相对信号强度(RSI),对差异有统计学意义的指标进一步进行多因素logistic回归分析。记录并比较2组术式、手术时间、术中出血量、术后并发症发生情况及手术前后疼痛视觉模拟量表(VAS)评分。结果2组在BMI、病程、Pfirrmann分级、LDH节段、LDH类型、MRI上椎间盘突出组织RSI这6个方面差异有统计学意义(P<0.05)。将上述6个指标纳入多因素logistic回归分析,结果显示,BMI越大、病程越长、LDH节段越低,突出椎间盘发生钙化的风险越高。与非钙化组相比,钙化组采用开放手术治疗的比例更高,手术时间更长、术中出血量更多,术后并发症发生率更高,差异均有统计学意义(P<0.05)。2组术后各随访时间点VAS评分较术前改善,差异均有统计学意义(P<0.05);钙化组术后6个月VAS评分较非钙化组改善更明显,差异有统计学意义(P<0.05);其余各时间点组间差异均无统计学意义(P>0.05)。结论BMI大、病程长、LDH节段低,是突出椎间盘发生钙化的危险因素。椎间盘钙化患者选择开放手术的比例更高,其手术时间更长、术中出血量更多、术后并发症发生率更高。Objective To explore the influencing factors of calcification after lumbar disc herniation(LDH)and its influence on surgical selection and prognosis.Method From January 2019 to August 2022,the clinical data of 420 patients with LDH admitted to Northern Jiangsu People’s Hospital Affiliated to Yangzhou University were retrospectively analyzed.The patients were divided into the calcified group(n=157)and non-calcified group(n=263)based on whether the herniated intervertebral disc was calcified.Univariate analysis was performed to compare age,gender,body mass index(BMI),disease duration,combined basic diseases(hypertension and/or diabetes),Pfirrmann grading of intervertebral disc degeneration,LDH segment,LDH type,relative signal intensity(RSI)of herniated tissue on MRI between the 2 groups.The statistically significant influencing factors were further included in multivariate logistic regression analysis.The surgical methods,operation time,intraoperative blood loss,incidence of postoperative complications,and pre-and post-operative pain visual analog scale(VAS)scores of the 2 groups were recorded and compared.Results There were statistically significant differences between the 2 groups in 6 indicators:BMI,disease duration,Pfirrmann grading,LDH segment,LDH type,relative signal intensity(RSI)of herniated tissue on MRI(P<0.05).The 6 indicators mentioned above were included in the multivariate logistic regression analysis,and the results showed that the higher the BMI,the longer the disease duration,and the lower the LDH segment,the higher the risk of calcification in herniated intervertebral discs.Compared with the non-calcified group,the calcified group had a higher proportion of open surgical treatment,longer operation time,more intraoperative blood loss,and a higher incidence of postoperative complications,all with a statistically significant difference(P<0.05).The VAS scores of the 2 groups were improved at each follow-up time point,and the differences were statistically significant(P<0.05);the VAS score of the cal

关 键 词：腰椎 椎间盘移位 钙质沉积症 

分 类 号：R681.533.1[医药卫生—骨科学]