经皮内镜治疗腰椎间盘突出症术后再突出与脊柱骨盆矢状面参数的相关性分析

Correlation Analysis of Recurrent Lumbar Disc Herniation After Percutaneous Endoscopic Treatment and Spino-Pelvic Sagittal Parameters

目的 探讨经皮内镜治疗腰椎间盘突出症术后复发的危险因素。方法 将四川省骨科医院颈肩腰腿痛一科2019年1月至2020年1月经皮内镜手术治疗的腰椎间盘突出症患者218例作为研究对象,根据随访时的临床症状及影像学表现,分为再突出组(n=21)和未突出组(n=197)。比较两组患者性别、年龄、手术前一般情况、体重指数(BMI)、突出节段、手术入路及术前脊柱骨盆矢状面参数,包括骨盆倾斜角(PT)、骨盆入射角(PI)、骶骨倾斜角(SS)、腰椎前凸角(LL)、胸椎后凸角(TK)、矢状面偏移(SVA),采用多元Logistic回归模型分析术后复发的危险因素。结果 两组LL、SS比较差异有统计学意义(P<0.05),PT、PI、TK、SVA比较差异无统计学意义(P>0.05),LL、SS为腰椎间盘突出症患者经皮内镜手术后复发的危险因素。结论 LL、SS减少可能是腰椎间盘突出症患者经皮内镜治疗后发生术后再突出的危险因素。

Objective To explore the risk factors for recurrent lumbar disc herniation after percutaneous endoscopic spinal surgery.Methods A total of 218 patients with lumbar disc herniation who underwent percutaneous endoscopic spinal surgery in the first department of neck,shoulder,low back and leg pain of Sichuan Province Orthopedic Hospital from January 2019 to January 2020 were enrolled.They were divided into recurrent group(n=21)and non-recurrent group(n=197)according to their clinical symptoms and imaging manifestations at follow-up.The general conditions[gender,age,general condition before surgery,body mass index(BMI),protrusive segment,surgical approach]and preoperative spino-pelvic sagittal parameters[pelvic tilt(PT),pelvic incidence(PI),sacral slope(SS),lumbar lordosis(LL),thoracickyphosis(TK),and sagittal vertical axis(SVA)]were compared between the two groups.The risk factors for postoperative recurrence of lumbar disc herniation were analyzed by multiple Logistic regression model.Results There were statistically significant differences in LL and SS between the two groups(P<0.05),while there was no statistically significant difference in PT,PI,TK,and SVA between the two groups(P>0.05).LL and SS were risk factors for recurrence of lumbar disc herniation after percutaneous endoscopic surgery.Conclusion Decreased LL and SS may be risk factors for recurrence of lumbar disc herniation after percutaneous endoscopic spinal surgery.