经皮内镜下腰椎间盘切除术后腰椎间盘突出复发的危险因素分析

Risk factors of recurrent lumbar disc herniation after percutaneous endoscopic lumbar discectomy

目的评估经皮内镜下腰椎间盘切除术(PELD)后复发性腰椎间盘突出症(rLDH)的临床特征和危险因素。方法纳入2013年1月至2019年8月于我院接受单节段PELD治疗的942例腰椎间盘突出症患者,根据是否发生rLDH将其分为rLDH组和非rLDH组,比较两组患者的一般特征、影像学数据和手术参数,通过单因素及多因素logistic回归分析确定PELD后复发的危险因素。结果本组腰椎间盘突出症患者经PELD治疗后rLDH的发生率为6.05%(57/942)。rLDH组与非rLDH组年龄、性别、BMI、当前吸烟情况、腰痛持续时间、是否从事重体力劳动、椎间盘突出类型、小关节退变分级、手术时间和下床行走时间差异均有统计学意义(P均<0.05)。单因素logistic回归分析显示,PELD后rLDH的发生可能与年龄、性别、BMI、当前吸烟情况、是否从事重体力劳动、手术时间和下床行走时间有关(P均<0.05)。多因素logistic回归分析显示,年龄较大(OR=1.210,95%CI 1.145~1.279,P<0.001)、男性(OR=0.396,95%CI 0.174~0.889,P=0.027)、BMI较大(OR=1.363,95%CI 1.201~1.547,P<0.001)、从事重体力劳动(OR=8.804,95%CI 3.069~25.257,P=0.003)和较早下床行走(OR=0.744,95%CI 0.685~0.809,P<0.001)是PELD后rLDH的危险因素。结论年龄较大、男性、较大的BMI、从事重体力劳动和较早下床行走是PELD后rLDH的危险因素,应高度重视这些危险因素并采取适当干预措施以预防rLDH的发生。

Objective To evaluate the clinical characteristics and risk factors of recurrent lumbar disc herniation(rLDH)after percutaneous endoscopic lumbar discectomy(PELD).Methods A total of 942 consecutive patients with lumbar disc herniation who underwent single-level PELD in our hospital from Jan.2013 to Aug.2019 were included.They were divided into rLDH group and non-rLDH group.Patient characteristics,radiographic parameters and surgical variables were compared between the 2 groups.Univariate and multivariate logistic regression analyses were used to determine the risk factors of recurrence after PELD.Results The prevalence of rLDH was 6.05%(57/942)in this study.There were significant differences in age,sex,body mass index(BMI),current smoking,duration of low back pain,occupational lifting,herniated disc type,facet joint degeneration,operation time and time to ambulation between the 2 groups(all P<0.05).Univariate logistic regression analysis showed that the incidence of rLDH after PELD might be related to age,sex,BMI,current smoking,occupational lifting,operation time,and time to ambulation(all P<0.05).Multivariate logistic analysis suggested that an older age(odds ratio[OR]=1.210,95%confidence interval[CI]1.145-1.279,P<0.001),the male sex(OR=0.396,95%CI 0.174-0.889,P=0.027),a large BMI(OR=1.363,95%CI 1.201-1.547,P<0.001),heavy work(OR=8.804,95%CI 3.069-25.257,P=0.003)and early ambulation(OR=0.744,95%CI 0.685-0.809,P<0.001)were risk factors for rLDH after PELD.Conclusion An older age,male sex,larger BMI,heavy work,and early ambulation are risk factors of rLDH after PELD.Great importance should be attached to these risk factors to prevent rLDH.