腰椎间盘突出症术后复发的相关因素分析

Experience in treatment of recurrent lumbar disc herniation

目的分析腰椎间盘突出症手术治疗后复发的相关因素，并探讨再手术治疗的方法，为改善患者预后积累经验。方法选取本院2008年1月～2014年12月接收的59例椎间盘摘除术后复发的腰椎间盘突出症患者为观察组；同期接收的348例行椎间盘摘除术后未复发患者为对照组。对两组患者临床资料进行回顾性分析，采用单因素及logistic回归多因素分析腰椎间盘突出症手术后复发的相关因素。将59例腰椎间盘突出症手术后复发患者采用随机数字法分为2组，A组（30例）采用全椎板切除术联合横突间植骨术，B组（29例）采用全椎板切除术联合椎弓根钉内固定术，比较两组优良率。结果单因素分析结果提示：年龄、病程、手术时间、术中出血量、手术节段是复发性腰椎间盘突出症的危险因素差异有统计学意义（P〈0．05），而体重指数、高血压病史、糖尿病病史、椎阃盘突出类型、椎间盘突出位置不是复发性腰椎间盘突出症的危险因素差异（P〉0．05）。logistic多因素分析提示：年龄、病程、术中出血量、手术节段是复发性腰椎间盘突出症的危险因素（P〈0．05），而手术时间不是复发性腰椎间盘突出症的危险因素差异无统计学意义（P〉0．05）。A组治疗优良率为53．3％，B组为82．7％，两组的治疗优良率经过统计学处理，差异具有统计学意义（χ^2=5．848，P=0．025）。结论对于年龄≥50岁、病程≥4年的腰椎间盘突出症患者，应慎重选择手术治疗方法，对于复发性腰椎间盘突出症的高危患者，应该加强监护，对于再手术治疗患者，加强术前检查、术中操作，有助于改善患者预后。

Objective To analyze the related factors of recurrence after surgical treatment of lumbar disc herniation, explore the method of re operation treatment and improve the prognosis of patients with lumbar disc herniation. Methods 59 patients with recurrent lumbar disc herniation were selected. The patients with recurrent lumbar disc herniation were in the observation group, and 348 cases without recurrence were in the control group. The clinical data of the two groups were retrospectively analyzed, and the related factors of recurrence of lumbar disc herniation were analyzed by single factor and logistic regression analysis. 59 cases with lumbar disc herniation after surgery recurrence patients with randomly divided into group A （30 cases） by laminectomy with transverse process bone graft between and group B （29 cases） by total laminectomy and pedicle screw internal fixation. The clinical effect was observed. Results The age, duration of disease, operative time, bleeding volume and operative segment were risk factors for recurrent lumbar disc hernia- tion （P〈0.05）, and body mass index, history of hypertension, diabetes mellitus, disc herniation and lumbar disc herniation were not risk factors for recurrent lumbar disc herniation （P〉0.05）. Logistic multivariate analysis indicated that age, duration of disease, bleeding volume and operative segment were the risk factors for recurrent lumbar disc herniation （P〈0.05）, and the operative time was not a risk factor for recurrent lumbar disc herniation （P〉0.05）. The excellent and good rate of group A and group B were 53.3 % and 82.7 % （χ^2= 5. 848, P=0. 025）. Conclusion The surgical treatment should be carefully chosen for lumbar disc herniation patients with age over 50 years and duration more than or equal to 4 years. The patients at high risk for recurrent lumbar disc herniation should strengthen monitoring and preoperative examination and operation, which can help to improve the prognosis of the patients.