腰椎间盘突出症后路内窥镜髓核摘除联合纤维环缝合术疗效的预测因素分析

Analysis of predictive factors for good prognosis of lumbar disc herniation by minimally invasive nucleotomy combined with annulus fibrous suture

目的研究分析后路内窥镜髓核摘除(microendoscopy discectomy,MED)联合纤维环缝合术预后良好的相关因素。方法纳入本科自2016年8月~2019年8月行MED联合纤维环缝合术治疗的133例腰椎间盘突出症(Lumbar disc herniation,LDH)患者,按“预后良好标准”(腰痛VAS评分改善24%以上,腿痛VAS评分改善39%以上,ODI指数改善33%以上,同时ODI指数<48%),评测患者术后3、6、12个月的VAS和ODI,并分析其相关临床资料,采用Logistic回归分析以确定手术获得良好预后的相关因素,包括患者特征、手术数据和影像学结果,椎间盘、小关节和终板形态等。结果133例患者均顺利完成该手术,但在不同观察时间均有失访,其中术后3个月获访131例,6个月获访129例,12个月获访126例。3、6和12个月后,131例患者中97例(74%)、129例患者中104例(81%)和126例患者中112例(89%)达到了成功标准;在总体上,所有患者术后的腰痛和下肢痛VAS评分、ODI指数均呈显著下降趋势。患者术后复发率为1.5%,再手术率为3.0%。随访3个月时,年轻患者(17~40岁)达到成功标准的比例较高(P=0.025)。Logistic回归分析显示,性别(男性)、体重指数偏低、基线VAS评分和ODI评分较高、术前椎间盘退变程度低、术后无并发症,与预后良好有关。结论MED联合纤维环缝合术治疗LDH影响预后良好的因素为:男性,体重指数偏低、基线VAS评分和ODI评分较高、术前椎间盘退变程度低、术后无并发症。

Objective To study and analyze the related factors of good prognosis of microendoscopy discectomy(MED)combined with annulus fibrosus suture.Methods From August 2016 to August 2019,133 patients with lumbar disc herniation(LDH)who underwent MED combined with annulus fibrosus suture in our department were included in this study.The prognosis of the patients at 3,6 and 12 months after operation was analyzed,and the relevant clinical data were analyzed.Logistic regression analysis was used to determine the important predictors of good prognosis(including patients’characteristics,surgical data and imaging results,such as intervertebral disc,facet joint and endplate morphology,etc.).The criteria for good prognosis were defined as the improvement of low back pain VAS score by more than 24%,leg pain VAS score by more than 39%,ODI index by more than 33%,and ODI index by less than 48%.Results All 133 patients completed the operation successfully,but lost follow-up at different observation time,including 131 cases at 3 months after operation,129 cases at 6 months after operation and 126 cases at 12 months after operation.After 3,6 and 12 months,97 patients of 131 cases(74%),104 patients of 129 cases(81%)and 112 patients of 126 cases(89%)met the success criteria.In general,the VAS score and ODI index of low back pain and lower limb pain decreased significantly in all patients.The postoperative recurrence rate was 1.5%,and the reoperation rate was 3.0%.During the 3-month follow-up,a higher proportion of young patients(17-40 years old)reached the standard of success(P=0.025).Logistic regression analysis showed that gender(male),low body mass index,high baseline VAS score and ODI score,low degree of preoperative intervertebral disc degeneration and no postoperative complications were all related to the success of treatment.Conclusion The prognostic factors of MED combined with annulus fibrosus suture in the treatment of LDH are male,low body mass index,high baseline VAS score and ODI score,low degree of preoperative disc degeneration and no postoperative complications.