腰椎间盘突出症患者经皮椎间孔镜下髓核摘除术后复发的影响因素分析

Analysis of factors affecting recurrence after percutaneous intervertebral foraminoscopic nucleus pulposus removal in patients with lumbar disc herniation

目的分析腰椎间盘突出症(LDH)患者经皮椎间孔镜下髓核摘除术(PELD)后复发的影响因素。方法将2017年6月-2023年6月期间入住青海仁济医院的300名LDH患者列为研究对象,依据患者术后是否复发分为复发组(n=23)和对照组(n=277)。回顾性分析300名LDH患者临床资料,采用多因素二元Logistic回归分析有差异项目,分析影响PELD术后复发的因素。结果300例LDH患者经皮椎间孔镜下髓核摘除术后复发23例,复发率为7.67%。单因素分析显示,年龄、病程、体质量指数(BMI)、疾病类型、合并糖尿病、吸烟史、术中髓核摘除情况可能成为LDH患者术后复发的影响因素(P<0.05)。多因素二元Logistic回归分析表明,年龄≥60岁、病程较长、BMI≥24kg/m2、突出型LDH患者、合并糖尿病、存在吸烟史及术中髓核不彻底摘除是导致LDH患者术后复发的影响因素(OR值>1,P<0.05)。结论PELD术后复发问题需得到重视,年龄≥60岁、病程较长、BMI≥24kg/m2、突出型LDH患者、合并糖尿病、存在吸烟史及术中髓核不彻底摘除更易导致PELD术后复发,临床应予以积极干预,进而降低患者复发风险。

Objective To analyze the influencing factors of recurrence after percutaneous intervertebral laminectomy for nucleus pulposus removal(PELD)in patients with lumbar disc herniation(LDH).Methods Three hundreds LDH patients admitted to our hospital between June 2017 and June 2023 were included as study subjects,and were divided into a recurrence group(n=23)and a control group(n=277)based on whether the patients had recurrence after surgery.The clinical data of 300 LDH patients were retrospectively analyzed,and multifactorial binary logistic regression was used to analyze the differentiated items and the factors affecting the postoperative recurrence of PELD.Results There were 23 cases of recurrence after percutaneous intervertebral laminectomy for nucleus pulposus removal(PELD)in 300 LDH patients,with a recurrence rate of 7.67%.Univariate analysis showed that age,disease duration,body mass index(BMI),disease type,comorbid diabetes mellitus,smoking history,and intraoperative nucleus pulposus removal may be the influencing factors of postoperative recurrence in patients with LDH(P<0.05).Multifactorial binary logistic regression analysis showed that age≥60 years,longer disease duration,BMI≥24 kg/m2,patients with protruding LDH,comorbid diabetes mellitus,presence of smoking history,and incomplete intraoperative medulla removal were the influencing factors leading to postoperative recurrence in patients with LDH(OR value>1,P<0.05).Conclusion The problem of postoperative recurrence of PELD needs to be emphasized.Age≥60 years old,long duration of disease,BMI≥24 kg/m2,herniated LDH patients,combined diabetes mellitus,history of smoking,and incomplete removal of the nucleus pulposus during surgery are more likely to lead to postoperative recurrence of PELD,and the clinic should actively intervene in order to reduce the risk of recurrence in patients.