内窥镜下椎间盘切除术治疗腰椎间盘突出症术后复发的影响因素分析

Influential factors for recurrent lumbar disc herniation after microendoscopic discectomy

目的：回顾性分析内窥镜下椎间盘切除术（MED）治疗腰椎间盘突出症术后复发的发生率及影响因素。方法：2009年1月-2014年1月年经MED治疗的单节段腰椎间盘突出症患者共322例,男203例,女119例;年龄39±12岁（14-84岁）;随访28.6±17.8个月（12-68个月）。应用日本骨科协会腰椎功能评分（腰椎JOA评分）评价治疗效果。采用卡方检验分别分析MED术后复发与年龄、性别、职业、体重指数、节段、突出类型、突出部位、术后活动程度等因素的关系。通过Logistic回归对MED术后复发的相关因素进行多因素分析。结果：术后21例患者复发,复发率为6.5%,其中19例为同部位复发,2例为对侧部位复发。复发时间为术后13.6±17.8个月（1-60个月）,其中16例（76.2%）为MED术后1年内复发。单因素卡方分析显示突出类型及术后活动程度与MED术后复发有关,而与性别、年龄、职业、体重指数、节段、突出部位无显著相关性;多因素Logistic回归分析显示突出类型（P=0.009,OR=2.762,CI=1.282-5.942）、术后活动程度（P=0.026,OR=1.907,CI=1.079-3.370）与术后复发显著性相关。结论：脱出型、游离型及高强度术后活动程度为MED术后复发的危险因素。

Objectives：To investigate the recurrence rate after microendoscopic discectomy（MED）for lumbar disc heniation（LDH）retrospectively,and to explore the influential factors related to recurrence.Methods：From January 2009 to January 2014,322 patients with single-level LDH who underwent MED were enrolled in this study.There were 203 males and 119 females（age range,14-84 years; mean age,39 ±12 years; follow-up range,12-68 months; mean follow-up,28.6 ±17.8 months）.The clinical curative effect was evaluated by using lumbar JOA score system.The influential factors were investigated including age,gender,occupation,body-mass index（BMI）,postoperative activity level,and level,type,site of LDH.The relationships between the variables and recurrent LDH were evaluated by single factor chi-squared and multiple logistic regression analysis.Results：Recurrent LDH was observed in 21 patients（6.5%）.There were 19 cases at the same level in the ipsilateral side as the original LDH,and 2 cases in the contralateral side.The mean time interval between MED and recurrence was 13.6 ±17.8 months（range,1-60 months）.There were 16（76.2%）recurrent patients within 1 year after MED.Single factor chi-squared analysis revealed herniation type and postopera-tive activity level significantly related with recurrent LDH,which had no significant correlation with other fac-tors including age,gender,occupation,body-mass index（BMI）,level and site of LDH.Multivariate analysis showed that herniation type and postoperative activity level were risk factors for recurrent LDH（P=0.009,OR=2.762,CI=1.282-5.942; P=0.026,OR=1.907,CI=1.079-3.370,respectively）.Conclusions：Our study suggests that extrusion,sequestration and high-intensity of postoperative activity level may significantly increase the in-cidence of recurrent LDH.