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CT定位内镜椎间盘切除术后复发的相关因素

Factors related to recurrence after CT guided endoscopic discectomy
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摘要 [目的]总结10年间采用CT定位内镜椎间盘切除(CT guided endoscopic discectomy, CTED)术后复发病例资料,探讨复发原因和防治对策。[方法]回顾分析2010年6月—2020年6月本院采用CTED治疗的3339例腰椎间盘突出症患者。随访观察是否术后复发,采用单项因素和二元多因素逻辑回归分析复发的相关因素。[结果]所有患者随访(68.18±33.42)个月。3 339例患者中,177例复发,复发率5.30%。复发组与未复发组在性别、初次术前病程、手术时间和首次手术髓核取出量比较差异无统计学意义(P>0.05);复发组的年龄、体重指数、第二次手术取出髓核量、两次手术取出髓核量总和均显著大于未复发组(P<0.05)。单节段突出复发率为4.93%;双节段突出复发率为8.95%,差异有统计学意义(P<0.05)。双节段突出者中仅对症状重的责任节段手术的复发率为5.80%;分两期手术的复发率为13.95%;同期手术的复发率19.57%,三种手术策略的复发率差异有统计学意义(P<0.05)。逻辑回归表明:年龄、体重指数、手术节段和双节段及手术方式是复发的危险因素(P<0.05)。[结论]椎间盘退变程度、手术创伤和外力因素与复发关联密切。应根据复发原因采取相应的预防措施,而CTED技术仍然是应对其复发后翻修的有效手段。 [Objective] To summarize and analyze the data of recurrence secondary to CT guided endoscopic discectomy(CTED) in the past ten years, and to explore the causes of recurrence, prevention and treatment measures as well. [Methods] A retrospective study was conducted on 3 339 patients who received CTED for lumbar intervertebral disc herniation in our hospital from June 2010 to June 2020.Based on whether or not postoperative recurrence occurred during follow-up period, the patients were divided into the recurrence group and non-recurrence group. The factors related to recurrence were searched by univariate analysis and binary multiple logistic regression. [Results] All the patients were followed up for(68.18±33.42) months. Among the 3339 patients, 177 were diagnosed as recurrence and underwent revision surgeries, accounted for 5.30%. Although there was no significant difference between the two groups regarding gender, course of disease before the primary operation, operation time, and the amount of nucleus pulposus removed in the first operation(P>0.05), the recurrence group was significantly greater than the non-recurrence group in age, body mass index, and amount of nucleus pulposus removed in the second operation, and the total amount of nucleus pulposus removed by the two operations(P<0.05);additionally the former had significantly greater ratio of L4-5 involved than the latter(P<0.05). In term of single or double segments involved, the recurrence rate was of4.93% in the single-segment protrusion, whereas 8.95% in the double-segment protrusion, which was statistically significant(P<0.05).For patients with double segments involved, the recurrence rate was of 5.80% in surgery at the responsible segment with severe symptoms only, whereas 13.95% in two-stage surgeries, and 19.57% in surgeries at one-stage for both segments, which proved statistically significant(P<0.05). As results of logistic regression, the age, body mass index, surgical segment, double segment and surgical method were risk factors for recurrence(P<0.05). [Conclusion] The extent of intervertebral disc degeneration, surgical trauma and external force factors are closely related to recurrence. Corresponding preventive measures should be taken according to the cause of the recurrence, and the CTED is still an effective means to deal with the recurrence.
作者 关家文 韩大鹏 卢昕 刘香玲 GUAN Jia-wen;HAN Da-peng;LU-xin;LIU Xiang-ling(Department of Spine Surgeryy Shandong Armed Police Corps Hospital,Jinan 250014,China)
出处 《中国矫形外科杂志》 CAS CSCD 北大核心 2021年第13期1153-1156,共4页 Orthopedic Journal of China
关键词 腰椎间盘突出症 CT定位内镜椎间盘切除术 复发 相关因素 lumbar disc herniation CT guided endoscopic discectomy recurrence relative factors
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