腰椎间盘突出症患者椎间孔镜手术后复发的危险因素分析

Analysis on the Risk Factors of Recurrence of Lumbar Disc Herniation in Patients after Intervertebral Foramen Surgery

目的探讨腰椎间盘突出症(lumbar disc herniation,LDH)患者椎间孔镜手术后复发的危险因素。方法回顾性分析2016年1月至2017年2月我院接收的130例经椎间孔镜手术后治疗的LDH患者的临床资料,根据术后1年内是否复发将其分为复发组(13例)和未复发组(117例),采用单因素和多因素Logistic回归分析法明确影响LDH患者椎间孔镜手术后复发的相关因素。结果复发组和未复发组性别、身体质量指数(body mass index,BMI)、高血压、糖尿病、高血脂症、LDH类型、突出位置、手术方式、手术时间患者的构成比的比较,差异无统计学意义(P>0.05)。复发组年龄≥60岁、病程≥4年、腰椎间盘轻中度退变、手术节段L4～5、术后椎间活动度≥10°、术中纤维环破损、术中髓核摘除不彻底患者的构成比与未复发组比较显著较高(P<0.05),且经过Logistic回归分析证实均是导致LDH患者椎间孔镜手术后复发的独立危险因素(OR=6.352、5.201、3.317、7.894、3.006、1.389、2.476,P=0.000、0.000、0.001、0.000、0.005、0.036、0.000)。结论导致LDH患者椎间孔镜手术后复发的危险因素较多,提示临床需高度重视存在相应危险因素的患者,给予针对性预防措施降低术后复发率。

Objective To investigate the risk factors for recurrence after intervertebral foramen surgery in patients with lumbar disc herniation (LDH).Methods The clinical data of 130 patients with LDH who underwent transforaminal surgery received from hospital from January 2016 to February 2017 were retrospectively analyzed.According to whether there was recurrence within 1 year after surgery,they were divided into recurrent group (13 cases) and non-recurred group (117 cases).The identify factors associated with recurrence after intervertebral foramen surgery in patients with LDHwere determined by single factor and multivariate logistic linear regression analysis.Results There were no differences in the rates of gender,body mass index (BMI),hypertension,diabetes,hyperlipidemia,LDH type,prominent position,surgical procedure,operation time between the recurrent group and the non-recurred group (P >0.05),while the rates of age ≥60 years,duration ≥4 years,mild or moderate degeneration of lumbar disc,L 4~5 of surgical segment,postoperative intervertebral activity ≥10°,intraoperative annulus fibrosus damage,incompletednucleus pulposus removalof the recurrent group were significantly higher than those of on-recurred group (P<0.05),which were the independent risk factors for recurrence after vertebral perforating surgery in patients with LDH (OR=6.352,5.201,3.317,7.894,3.006,1.389,2.476, P=0.000,0.000,0.001,0.000,0.005,0.036,0.000).Conclusion There are many risk factors for recurrence after intervertebral foramen surgery in patients with LDH,suggesting that patients with high risk factors should be highly regarded in clinical practice,and targeted preventive measures should be given to reduce the recurrence rate.