椎间孔镜下腰椎间盘切除术后早期复发危险因素分析

Risk factors and predictive efficacy analysis of early recurrence after lumbar discectomy under intervertebral foramen endoscopy

目的 探讨椎间孔镜下腰椎间盘切除术后早期复发危险因素并进一步分析上述指标风险预测效能。方法 回顾性纳入2019年6月至2023年2月于本院及上级医院行椎间孔镜下腰椎间盘切除术治疗腰椎间盘突出症患者共132例,根据术后随访6个月有无复发分为复发组(12例)和未复发组(120例);比较复发组和未复发组临床特征资料,并将证实有统计学意义指标纳入Logistics回归模型,评估椎间孔镜下腰椎间盘切除术后早期复发独立危险因素;描绘受试者工作特征(ROC)曲线评估上述独立危险因素用于椎间孔镜下腰椎间盘切除术后早期复发预测临床效能。结果 132例术后随访6个月内复发12例,复发率为9.09%;术后中位复发时间为69.0(7.0,158.0) d。两组椎间盘退变Pfirrmann分级情况、突出部位显著极外侧比例、Modic病变严重程度情况、椎间盘高度指数、突出物基底部宽度、术后纤维环破口水平及椎间孔面积比较差异有统计学意义(P<0.05)。Logistic回归模型多因素分析结果显示,突出基底部宽度增加、Modic病变程度加重及椎间孔面积缩小均是椎间孔镜下腰椎间盘切除术后早期复发独立危险因素(P<0.05)。ROC曲线分析结果显示,突出基底部宽度、Modic病变程度及椎间孔面积均可用于椎间孔镜下腰椎间盘切除术后早期复发风险预测,且上述指标联合预测效能显著优于单一指标及两两联合(P<0.05)。结论 椎间孔镜下腰椎间盘切除术后早期复发与突出基底部宽度增加、Modic病变程度加重及椎间孔面积缩小均密切相关;同时上述指标联合在预测椎间孔镜下腰椎间盘切除术后早期复发风险方面显示出更佳临床效能。

Objective To investigate the risk factors of early recurrence after lumbar discectomy under intervertebral foramen endoscopy and further analysis the predictive efficacy.Methods 132 patients with lumbar disc herniation who underwent lumbar discectomy under intervertebral foramen endoscopy in our hospital and the superior hospital from June 2019 to February 2023 were retrospectively included.They were divided into recurrence group(12 cases) and non-recurrence group(120 cases) based on whether there was recurrence after 6 months of follow-up;the clinical characteristics of the recurrent group and non-recurrent group were compared,and incorporate statistically significant indicators into the logistic re-gression model to evaluate independent risk factors for early recurrence after lumbar discectomy under intervertebral foramen endoscopy;Evaluating the independent risk factors mentioned above by depicting the subject's job characteristic(ROC) curve for predicting clinical efficacy in predicting early recurrence after lumbar discectomy under foraminal endoscopy.Results This study included 12 out of 132 patients who experienced recurrence within 6 months of postoperative follow-up,with a recurrence rate of 9.09%;The median postoperative recurrence time was 69.0(7.0,158.0)days.There was a statistically significant difference in the Pfirmann grading of intervertebral disc degeneration,the proportion of significantly more lateral protrusions,the severity of Modic lesions,the disc height index,the width of the protrusion base,the level of postoperative fibrous ring rupture,and the area of intervertebral foramen between 2 groups(P<0.05).The logistic regression model showed that an increase in the width of the protruding base,an aggravation of Modic lesion,and a reduction in intervertebral foramen area were all independent risk factors for early recurrence after lumbar discectomy under intervertebral foramen endoscopy(P<0.05).ROC curve analysis results show that the width of the protruding base,the degree of Modic lesion,and the area of the intervertebral foramen can all be used for predicting the risk of early recurrence after lumbar discectomy under in-tervertebral foramen endoscopy,and the combined prediction efficiency of the above indicators is significantly better than that of a single indicator or combination of each two indicators(P <0.05).Conclusion Early recurrence after lumbar discectomy under intervertebral foramen endoscopy is closely related to an increase in the width of the protruding base,an aggravation of Modic lesions,and a reduction in intervertebral foramen area;At the same time,the combination of the above indicators shows better clinical efficacy in predicting of the early recurrence risk after lumbar discectomy under intervertebral foramen endoscopy.