腰椎间盘突出症患者椎间孔镜手术后复发的危险因素分析
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摘要
目的探讨腰椎间盘突出症(lumbar disc herniation,LDH)患者椎间孔镜手术后复发的危险因素。方法回顾性分析2016年1月至2017年2月我院接收的130例经椎间孔镜手术后治疗的LDH患者的临床资料,根据术后1年内是否复发将其分为复发组(13例)和未复发组(117例),采用单因素和多因素Logistic回归分析法明确影响LDH患者椎间孔镜手术后复发的相关因素。结果复发组和未复发组性别、身体质量指数(body mass index,BMI)、高血压、糖尿病、高血脂症、LDH类型、突出位置、手术方式、手术时间患者的构成比的比较,差异无统计学意义(P>0.05)。复发组年龄≥60岁、病程≥4年、腰椎间盘轻中度退变、手术节段L4～5、术后椎间活动度≥10°、术中纤维环破损、术中髓核摘除不彻底患者的构成比与未复发组比较显著较高(P<0.05),且经过Logistic回归分析证实均是导致LDH患者椎间孔镜手术后复发的独立危险因素(OR=6.352、5.201、3.317、7.894、3.006、1.389、2.476,P=0.000、0.000、0.001、0.000、0.005、0.036、0.000)。结论导致LDH患者椎间孔镜手术后复发的危险因素较多,提示临床需高度重视存在相应危险因素的患者,给予针对性预防措施降低术后复发率。
Objective To investigate the risk factors for recurrence after intervertebral foramen surgery in patients with lumbar disc herniation(LDH).Methods The clinical data of 130 patients with LDH who underwent transforaminal surgery received from hospital from January 2016 to February 2017 were retrospectively analyzed.According to whether there was recurrence within 1 year after surgery,they were divided into recurrent group(13 cases)and non-recurred group(117 cases).The identify factors associated with recurrence after intervertebral foramen surgery in patients with LDHwere determined by single factor and multivariate logistic linear regression analysis.Results There were no differences in the rates of gender,body mass index(BMI),hypertension,diabetes,hyperlipidemia,LDH type,prominent position,surgical procedure,operation time between the recurrent group and the non-recurred group(P>0.05),while the rates of age≥60 years,duration≥4 years,mild or moderate degeneration of lumbar disc,L4～5 of surgical segment,postoperative intervertebral activity ≥10°,intraoperative annulus fibrosus damage,incompletednucleus pulposus removalof the recurrent group were significantly higher than those of on-recurred group(P<0.05),which were the independent risk factors for recurrence after vertebral perforating surgery in patients with LDH(OR=6.352,5.201,3.317,7.894,3.006,1.389,2.476,P=0.000,0.000,0.001,0.000,0.005,0.036,0.000).Conclusion There are many risk factors for recurrence after intervertebral foramen surgery in patients with LDH,suggesting that patients with high risk factors should be highly regarded in clinical practice,and targeted preventive measures should be given to reduce the recurrence rate.
Objective To investigate the risk factors for recurrence after intervertebral foramen surgery in patients with lumbar disc herniation(LDH).Methods The clinical data of 130 patients with LDH who underwent transforaminal surgery received from hospital from January 2016 to February 2017 were retrospectively analyzed.According to whether there was recurrence within 1 year after surgery,they were divided into recurrent group(13 cases)and non-recurred group(117 cases).The identify factors associated with recurrence after intervertebral foramen surgery in patients with LDHwere determined by single factor and multivariate logistic linear regression analysis.Results There were no differences in the rates of gender,body mass index(BMI),hypertension,diabetes,hyperlipidemia,LDH type,prominent position,surgical procedure,operation time between the recurrent group and the non-recurred group(P>0.05),while the rates of age≥60 years,duration≥4 years,mild or moderate degeneration of lumbar disc,L4～5 of surgical segment,postoperative intervertebral activity ≥10°,intraoperative annulus fibrosus damage,incompletednucleus pulposus removalof the recurrent group were significantly higher than those of on-recurred group(P<0.05),which were the independent risk factors for recurrence after vertebral perforating surgery in patients with LDH(OR=6.352,5.201,3.317,7.894,3.006,1.389,2.476,P=0.000,0.000,0.001,0.000,0.005,0.036,0.000).Conclusion There are many risk factors for recurrence after intervertebral foramen surgery in patients with LDH,suggesting that patients with high risk factors should be highly regarded in clinical practice,and targeted preventive measures should be given to reduce the recurrence rate.
引文
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[20]陈国勇,谢恩,张振兴,等.单纯髓核摘除术治疗腰椎间盘突出症术后复发的多元影响因素分析[J].中国骨与关节杂志,2018,12(6):234-238.
[21] Serra T,Capelli C,Toumpaniari R,et al.Design andfabrication of 3D-printed anatomically shaped lum-bar cage forintervertebral disc(IVD)degenerationtreatment[J].Biofabrication,2016,8(3):35-39.
[22]沙宇,周红刚,马海军,等.经皮椎间孔镜在腰椎间盘突出症治疗中的应用[J].实用骨科杂志,2012,18(5):437-439.
[2] Pan Z,Ha Y,Yi S,et al.Efficacy of transforaminalendoscopic spine system(TESSYS)technique intreating lumbar disc herniation[J].Med Sci Monit,2016,22(18):530-539.
[3]禤天航,刘效仿,曹正霖,等.经皮椎间孔镜与椎板开窗髓核摘除术治疗复发性腰椎间盘突出症的疗效比较[J].中国骨与关节损伤杂志,2016(9):972-974.
[4]孔庆奎,谢元忠,万大兰,等.CT多平面重建对腰椎间盘突出症的诊断[J].中华骨科杂志,2001,21(8):508-509.
[5]王欢.微创手术治疗腰椎间盘突出症的适应证[J].中国脊柱脊髓杂志,2003,13(7):294-297.
[6]周跃,李长青,王建,等.椎间孔镜YESS与TESSYS技术治疗腰椎间盘突出症[J].中华骨科杂志,2010,30(3):225-231.
[7]鲁玉来,刘晓光.腰椎间盘突出症[M].3版.北京:人民军医出版社,2014:155-156.
[8]林琳,朱燕波,史会梅,等.中国成年人群体质量指数与健康相关生命质量的关系:健康与慢病不同亚组的分层分析[J].中华行为医学与脑科学杂志,2014,23(7):639-643.
[9]张福明,王春江,邢利清.腰椎间盘突出症术中髓核摘除量的分析[J].中国骨与关节损伤杂志,2011,26(11):1020-1021.
[10] Jang TW,Ahn YS,Byun J,et al.Lumbar interverte-bral disc degeneration and related factors in Koreanfirefighters[J].BMJ Open,2016,6(6):115-118.
[11]何丽蔚,徐煜,颜程,等.老年人骨质疏松性骨折风险与脊柱活动能力及脊柱曲度的关系[J].中华全科医学,2017,15(4):687-689.
[12]柯东港.腰椎间盘突出症发病危险因素及CT影像特点分析[J].中国CT和MRI杂志,2016,14(6):133-136.
[13]高全有,韩康,高浩然,等.经皮椎板间内镜治疗腰椎间盘突出症临床疗效观察[J].中华全科医学,2016,14(7):1069-1072.
[14] Yao Y,Liu H,Zhang H,et al.Risk factors for recur-rent herniation after percutaneous endoscopic lum-bar discectomy[J].World Neurosurg,2017,100(2):1-6.
[15]郭涛,魏人前,邓睿.腰椎间盘突出症术后复发的相关因素分析[J].西部医学,2016,28(8):1110-1113.
[16]彭浩,黄文华.模拟肌肉在腰椎撞击伤中作用的生物力学研究[J].中华生物医学工程杂志,2017,23(2):137-139.
[17]袁鑫,孔超,陈学明,等.Wallis腰椎棘突间动态稳定系统对相邻节段椎体退变的中长期影响[J].中华外科杂志,2016,54(12):914-918.
[18] Menezes-Reis R,Bonugli GP,Dalto VF,et al.Associa-tion between lumbar spine sagittal alignment and L4~5disc degeneration among asymptomatic young adults[J].Spine(Phila Pa 1976),2016,41(18):E1081-1087.
[19]王剑锋,杨林.腰椎间孔镜术后复发的原因分析及对策[J].武警医学,2017,28(4):366-368.
[20]陈国勇,谢恩,张振兴,等.单纯髓核摘除术治疗腰椎间盘突出症术后复发的多元影响因素分析[J].中国骨与关节杂志,2018,12(6):234-238.
[21] Serra T,Capelli C,Toumpaniari R,et al.Design andfabrication of 3D-printed anatomically shaped lum-bar cage forintervertebral disc(IVD)degenerationtreatment[J].Biofabrication,2016,8(3):35-39.
[22]沙宇,周红刚,马海军,等.经皮椎间孔镜在腰椎间盘突出症治疗中的应用[J].实用骨科杂志,2012,18(5):437-439.