显微内镜腰椎间盘摘除技术治疗腰椎间盘突出症影响预后的因素

The factors to influence prognosis of microendoscopic discectomy for lumbar disc herniation

目的探讨显微内镜腰椎间盘摘除技术(MED)治疗腰椎间盘突出症的远期疗效及影响因素。方法对515例MED手术治疗患者进行远期随访Oswestry功能障碍指数(ODI)和MacNab疗效评定,分析性别、年龄、病程、病变节段、手术时间和出血量等因素对远期疗效的影响。结果 312例患者获得最终随访,平均随访时间7年。随访末期ODI评分平均7.5分,优良率73.7%;MacNab指数显效247例,有效62例,无效3例,显效率79.2%;两种评价指标具有较好的相关性(P<0.01)。MED术后远期ODI评分和MacNab指数均与患者的年龄、病程及病变节段具有明显的相关性。结论 MED治疗腰椎间盘突出症远期疗效满意,高龄、病程长、多节段病变是影响MED远期疗效的主要危险因素。

Objective To evaluate the long-term results of microendoscopic discectomy（MDE） in treatment of lumbar disc herniation and the factors to influence its prognosis.Methods A questionnaire survey was conducted in 515 patients underwent MED to investigate Oswestry disability index（ODI） and MacNab criteria.Prognostic factors including gender,age,course of disease,implicated segment,operation time and blood loss were evaluated by logistic regression analysis.Results A total of 312 patients（202 male and 110 female） obtained effective follow up with an average duration of 7 years.The mean ODI score was 7.5 and the excellent/good rate was 73.7% at the final follow-up.Outcomes based on MacNab criteria were good in 247 patients,fair in 62 and bad in 3 thereby indicating a significant symptomatic improvement in 79.2% of the patients.High correlation was obtained between ODI score and MacNab criteria（P〈0.01）.Logistic regression analysis showed both ODI score and MacNab criteria were closely related to age,course of disease and multiple segment lesions.Conclusion MED shows the satisfactory long-term results for the treatment of lumbar disc herniation.Elder patient,long course of disease and multiple segment lesions are the main risk factors for predicting the long-term results of MDE.