腰椎间盘突出症重吸收的影响因素分析

Influencing Factors of Resorption in Lumbar Disc Herniation

目的:探讨腰椎间盘突出症(LDH)发生重吸收的相关影响因素。方法:收集2016年4月—2019年12月在南京中医药大学附属苏州市中医医院首选非手术治疗并获得1年以上随访的LDH患者116例进行回顾性分析。根据末次随访时是否发生突出物重吸收,分为重吸收组45例和非重吸收组71例。记录2组患者的相关资料,包括临床因素(年龄、病程、性别)、椎间盘突出程度(Komori分型)、椎间盘突出组织成分[Iwabuchi分型、Pfirrmann分级、突出组织相对信号强度(RSI)]、影像学特点(相邻椎体Modic改变、椎管形态、神经根沉降征Schizas分型)等4个方面的信息。首先通过单因素分析筛查出2组患者中差异具有统计学意义的相关变量,然后对上述具有差异的变量进一步采用二元logistic回归分析,明确其是否是LDH发生重吸收的影响因素。结果:发生重吸收的45例患者临床症状明显改善,未发生重吸收的71例患者中最终23例患者行手术治疗。单因素分析结果显示,2组在年龄、病程、Komori分型、Iwabuchi分型、Pfirrmann分级、RSI、Modic改变、椎管形态、神经根沉降征Schizas分型等方面差异有统计学意义(P<0.05)。二元logistic回归分析结果显示,病程、Komori分型、Iwabuchi分型、RSI、Modic改变是LDH重吸收的独立影响因素(P<0.05),其中病程≤1年、Komori分型C型、Iwabuchi分型1型和5型、RSI相对较高、不伴有相邻椎体Modic改变者容易发生LDH重吸收。结论:病程、Komori分型、Iwabuchi分型、RSI、Modic改变是影响LDH重吸收的因素,其中病程≤1年、Komori分型C型、Iwabuchi分型1型和5型、RSI相对较高、不伴有相邻椎体Modic改变者容易发生LDH重吸收,对临床预测重吸收发生具有一定的指导意义。

Objective:To investigate the influencing factors of resorption in lumbar disc herniation(LDH).Methods:A total of 116 patients with LDH who were hospitalized in Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from April 2016 to December 2019 with non-surgical plan as the first treatment choice were selected and retrospectively analyzed.According to whether the resorption occurred at the last follow-up,the patients were divided into reabsorption group(45 cases)and non-reabsorption group(71 cases).The relevant data of the two groups were collected,including demographic and clinical factors(age,course of disease,gender),degree of LDH(Komori classification),tissue composition of LDH[Iwabuchi classification,LDH Pfirrmann classification,MRI relative signal intensity(RSI)],and MRI imaging characteristics(Modic changes in adjacent vertebral bodies,spinal canal morphology,horsetail sedimentation sign Schizas classification).Univariate analysis was conducted to find the indicators with statistical differences between the two groups,which were further analyzed by logistic regression to determine whether they were independent factors affecting the resorption of LDH.Results:The symptoms of 45 patients with resorption significantly improved,and of the 71 patients without resorption,23 patients underwent surgery.There were significant differences between the two groups in age,course of disease,Komori classification,Iwabuchi classification,Pfirrmann classification,RSI,Modic changes,spinal canal morphology and horsetail sedimentation sign Schizas classification(P<0.05).Further logistic analysis demonstrated that the course of disease,Komori classification,Iwabuchi classification,RSI,Modic changes were independent factors affecting resorption(P<0.05).Patients with course of disease≤1 year,Komori type C,Iwabuchi type 1 and type 5,relatively higher RSI and without Modic changes of adjacent vertebral bodies were prone to resorption after LDH.Conclusion:The course of disease,Komori classification,Iwabuchi classification,RSI and Modic changes are the influencing factors of resorption of LDH.Patients with course of disease≤1 year,Komori type C,Iwabuchi type 1 and type 5,relatively higher RSI,and without Modic changes of adjacent vertebral bodies are prone to resorption of LDH,which has certain guiding significance for clinical prediction of resorption.