椎间孔镜下治疗腰椎间盘突出症术后复发相关因素及再次处理效果探讨

Discussion of the Recurrent Factors and Reprocessing Effect in the Treatment of Lumbar Disc Herniation by Percutaneous Endoscopic Lumbar Discectomy

目的:回顾性分析行椎间孔镜手术的腰椎间盘突出症患者,探讨其术后复发率、相关因素及再次处理效果。方法:选取2015年1月至2017年1月在本院行椎间孔镜手术的腰椎间盘突出症378例患者为研究对象,计算其术后复发率,通过比较术后复发患者第一次手术前、复发后、末次随访时VAS及JOA评分来评价再次处理效果;通过单因素及多因素分析对术后复发相关因素进行分析。结果:术后复发共12例,复发率为3.17%.同侧复发11例,对侧复发1例。复发时间为0.5～11.0个月,平均(5.4±2.6)个月。末次随访时,术后复发患者VAS评分由(7.59±1.83)分降至(2.46±1.27)分,JOA评分由(11.97±1.89)分增至(27.34±1.91)分,单因素分析显示体质量指数(BMI)、突出类型及术后活动程度与术后复发有关,而性别、年龄、吸烟史、突出节段、突出部位与术后复发无显著相关性。多因素分析显示高强度术后活动程度、脱出型及游离型、高BMI是术后复发的危险因素。结论:高强度术后活动程度、脱出型及游离型、高BMI是术后复发的危险因素,对于椎间孔镜术后复发患者再次处理效果满意。

Objectives：To analyze the recurrent factors and investigate the reprocessing effect in the treatment of lumbar disc herniation by percutaneous endoscopic lumbar disceetomy （PELD）. Methads： From January 2015 to January 2017, 378 patients with lumbar disc herniation （LDH） who underwent PELD were enrolled in this study. The clinical effect was evaluated by using VAS and lumbar JOA score system. The influential factors were investigated, including the age, gen- der, BMI, protruding segment, herniation type, protruding position, postoperative activity level. Results： Recurrent LDH was observed in 12 patients （3.17%）. There were 11 cases at the same level in the ipsilateral side as the original LDH, and 1 cases in the eontralateral side. The VAS score was changed from（7.59 ± l. 83）to（2.46± 1.27）, while J OA score was from（ 11.97 ± 1.89） to （ 27.34 ±1.91 ）. Single factor analysis revealed that the age, gender, protruding segment and protruding position had no significant correlation with recurrent LDH. Multivariate analysis showed that postoperative ac- tivity level, herniation type, BMI were risk factors for recurrent LDH. Conclusion： Our study suggests that high-intensity of postoperative activity level, extrusion, sequestration and high BMI may significantly increase the incidence of recurrent LDH. Our measures for recurrent LDH had got a satisfactory result.