经皮椎间孔镜下椎间盘切除术后腰椎间盘突出复发的危险因素研究

    Study on the risk factors of recurrence of lumbar disc herniation after percutaneous transforaminal endoscopic discectomy

    • 摘要:
      目的分析经皮椎间孔镜下椎间盘切除术(PTED)治疗腰椎间盘突出症(LDH)术后复发的危险因素。
      方法选择采用PTED治疗的LDH病人186例,随访2~4年,比较不同临床特征病人的术后复发率,采用logistic回归分析方法分析LDH术后复发的独立危险因素。
      结果186例LDH病人PTED术后复发20例,复发率为10.75%。不同纤维环破裂口大小、术后长期吸烟、LDH类型、术后活动程度、年龄、术后节段活动度、体质量指数病人的术后复发率差异均有统计学意义(P < 0.05~P < 0.01);而不同性别、合并糖尿病、不同病程病人术后复发率差异均无统计学意义(P>0.05)。logistic回归分析显示,纤维环破裂口>5 mm、游离脱出型LDH、术后活动程度评分>6分、年龄>70岁均为PTED治疗LDH术后复发的独立危险因素(P < 0.05)。
      结论PTED治疗LDH术后复发与纤维环破裂口大小、LDH类型、术后活动程度、年龄等具有明显关系,加强术前检查、注意术中操作及术后康复可以减少LDH复发。

       

      Abstract:
      ObjectiveTo investigate the risk factors of recurrence of lumbar disc herniation(LDH) after percutaneous transforaminal endoscopic discectomy(PTED).
      MethodsA total of 186 patients with LDH treated with PTED were followed up for 2 to 4 years.The recurrence rates of patients were compared among the different clinical characteristics, and the logistic regression analysis was used to investigate the independent risk factors of postoperative recurrence.
      ResultsTwenty cases of 186 LDH patients recured after PTED, the recurrence rate of which was 10.75%.The differences of the postoperative recurrence rates among the patients with different sizes of fibrous ring rupture, long-term smoking, LDH type, postoperative activity, age, postoperative segmental mobility and body mass index were statistically significant(P < 0.05 to P < 0.01), and the differences of the postoperative recurrence rates among the patients with different genders, combined diabetes and course of disease were not statistically significant(P>0.05).The results of logistic regression analysis showed that the long-term smoking after surgery, fibrous ring rupture more than 5 mm, free-out LDH, postoperative activity score more than 6 points and age more than 70 years were the independent risk factors of recurrence of LDH after PTED(P < 0.05).
      ConclusionsThe recurrence of LDH after PTED is obviously correlated with the fibrous ring rupture size, LDH type, postoperative activity degree and age.The preoperative examination should be strengthened, and the intraoperative procedures and postoperative rehabilitation should be paid attention to reduce LDH recurrence.

       

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