| 张国强,杨 雍,李锦军,谢学虎,刘 宁.经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症的临床疗效及术后复发的影响因素分析[J].,2021,(5):857-861 |
| 经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症的临床疗效及术后复发的影响因素分析 |
| Clinical Efficacy of Percutaneous Transforaminal Endoscopic Discectomy for Lumbar Disc Herniation and Influencing Factors of Postoperative Recurrence |
| 投稿时间：2020-07-27 修订日期：2020-08-23 |
| DOI：10.13241/j.cnki.pmb.2021.05.011 |
| 中文关键词: 经皮椎间孔镜下髓核摘除术 腰椎间盘突出症 临床疗效 复发 影响因素 |
| 英文关键词: Percutaneous endoscopic discectomy Lumbar disc herniation Clinical efficacy Recurrence Influencing factors |
| 基金项目:北京市医院管理局临床医学发展专项（XMLX201713） |
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| 中文摘要: |
| 摘要 目的：探讨经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症（LDH）的临床疗效，分析术后复发的影响因素。方法：选取我院于2017年2月~2019年12月期间收治的LDH患者230例，均给予经皮椎间孔镜下髓核摘除术治疗，观察其疗效、不同时间点视觉疼痛模拟评分量表（VAS）、Oswestry功能障碍指数（ODI）评分及并发症。记录LDH术后复发（PRLDH）率。采用单因素及多因素Logistic回归分析PRLDH的影响因素。结果：230例LDH患者采用经皮椎间孔镜下髓核摘除术治疗后，优69例，良117例，可34例，差10例，优良率为80.87%（186/230）。LDH患者术后3个月、术后6个月VAS、ODI评分均较术前降低，且术后3个月~术后6个月VAS、ODI评分呈降低趋势，差异均有统计学意义（P<0.05）。LDH患者术后并发症发生率为5.22%（12/230）。发生PRLDH的患者为29例，复发率为12.61%（29/230）。单因素分析显示，PRLDH与年龄、吸烟、体质量指数、糖尿病、髓核突出/脱出、病程有关（P<0.05）；多因素Logistic回归分析显示，年龄≥60岁、吸烟、体质量指数≥24kg/m2、糖尿病、髓核突出/脱出、病程≥6个月均是PRLDH复发的影响因素（P＜0.05）。结论：经皮椎间孔镜下髓核摘除术用于LDH的治疗，疗效稳定，可较好的促进患者疼痛症状的改善，加快腰椎功能的恢复，但术后复发问题需得到重视，年龄≥60岁、吸烟、体质量指数≥24kg/m2、糖尿病、髓核突出/脱出、病程≥6个月均是PRLDH的影响因素。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the clinical efficacy of percutaneous transforaminal endoscopic discectomy in the treatment of lumbar disc herniation (LDH), and to analyze the influencing factors of postoperative recurrence. Methods: 230 cases of LDH patients in our hospital from February 2017 to December 2019 were selected. All patients were treated with percutaneous transforaminal endoscopic discectomy. The curative effect, visual analogue scale (VAS) at different time points, Oswestry disability index (ODI) score and complications observed. The recurrence rate of LDH (PRLDH) was recorded. The influencing factors of PRLDH were analyzed by univariate and multivariate Logistic regression analysis. Results: Among 230 patients with LDH after treatment by percutaneous transforaminal endoscopic discectomy, 69 cases were excellent, 117 cases were good, 34 cases were fair and 10 cases were poor. The excellent and good rate was 80.87% (186 / 230). The VAS and ODI scores of LDH patients at 3 months and 6 months after operation were gradually decreased compared with those before operation, VAS and ODI scores decreased from 3 months to 6 months after operation, the differences were statistically significant (P<0.05). The incidence rate of postoperative complications of LDH patients was 5.22% (12/230). There were 29 patients with PRLDH, the recurrence rate was 12.61% (29/230). Univariate analysis showed that PRLDH was related to age, smoking, body mass index, diabetes mellitus, nucleus pulposus and course of disease (P<0.05). Multivariate Logistic regression analysis showed that age ≥60 years old, smoking, body mass index ≥ 24 kg/m2, diabetes mellitus, prolapse of nucleus pulposus/prolapse, course of disease ≥6 months were the influencing factors of PRLDH (P<0.05). Conclusion: Percutaneous transforaminal discectomy in the treatment of LDH, the curative effect is stable, can better promote the improvement of pain symptoms, accelerate the recovery of lumbar function, however, attention should be paid to the postoperative recurrence. Age ≥60 years old, smoking, body mass index ≥24kg / m2, diabetes mellitus, prolapse of nucleus pulposus/prolapse, course of disease ≥6 months are the influencing factors of PRLDH. |
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