不同入路椎间孔镜技术治疗高位腰椎间盘突出症的效果及随访复发影响因素分析

Effect of transforaminal technique via different approaches in the treatment of upper lumbar disc herniation and analysis of the influencing factors of recurrence during follow-up

目的探讨不同入路椎间孔镜技术治疗高位腰椎间盘突出症(ULDH)的效果及随访复发的影响因素。方法回顾性分析2019年1月至2022年1月收治的120例行椎间孔镜技术治疗的ULDH患者临床资料,根据手术入路不同将其分为经皮内镜椎间孔入路椎间盘切除术(PETD)组(PETD治疗)和经皮内镜椎板间入路椎间盘切除术(PEID)组(PEID治疗),每组60例。比较两组的Oswestry功能障碍指数(ODI)、视觉模拟评分法(VAS)评分以及随访复发率;采用多因素Logistic回归分析探讨随访复发的危险因素。结果术后3 d、3个月、6个月,两组的ODI、VAS评分低于术前(P<0.05);术后3 d,PEID组的ODI评分低于PETD组(P<0.05);术后3个月,PEID组的VAS评分高于PETD组(P<0.05)。PETD组的随访复发率高于PEID组(P<0.05)。复发组的体质指数(BMI)≥24 kg/m^(2)、饮酒史、糖尿病、突出型占比均高于未复发组(P<0.05)。BMI≥24 kg/m^(2)、饮酒史、糖尿病、突出型、PETD为随访复发的危险因素(P<0.05)。结论PETD、PEID两种入路治疗ULDH均有效,且PEID效果更优;高BMI、饮酒、糖尿病、突出型、PETD为随访复发的危险因素。

Objective To investigate the effect of transforaminal technique via different approaches in the treatment of upper lumbar disc herniation(ULDH)and analysis of the influencing factors of recurrence during follow-up.Methods The clinical data of 120 patients with ULDH who underwent transforaminal technique admitted from January 2019 to January 2022 were retrospectively analyzed.According to the different surgical approaches,the patients were divided into percutaneous endoscopic transforaminal discectomy(PETD)group(treated with PETD)and percutaneous endoscopic interlaminar discectomy(PEID)group(treated with PEID),with 60 cases in each group.The Oswestry Disability Index(ODI),Visual Analogue Scale(VAS)scores and recurrence rate during follow-up were compared between the two groups;multivariate Logistic regression analysis was used to explore the risk factors of recurrence during follow-up.Results At 3 d,3 months and 6 months after operation,the ODI and VAS scores of the two groups were lower than those before operation(P<0.05);at 3 d after operation,the ODI score of the PEID group was lower than that of the PETD group(P<0.05);at 3 months after operation,the VAS score of the PEID group was higher than that of the PETD group(P<0.05).The recurrence rate during follow-up of the PETD group was higher than that of the PEID group(P<0.05).The proportions of body mass index(BMI)≥24 kg/m^(2),alcohol drinking history,diabetes and prominent type in the recurrent group were higher than those in the non-recurrent group(P<0.05).BMI≥24 kg/m^(2),alcohol drinking history,diabetes,prominent type and PETD were risk factors for recurrence during follow-up(P<0.05).Conclusion Both PETD and PEID are effective in the treatment of ULDH,and PEID is more effective.High BMI,alcohol drinking,diabetes,prominent type,and PETD were risk factors for recurrence during follow-up.