摘要
目的:分析腰椎间盘突出症(LDH)患者经皮脊柱内镜下腰椎间盘切除术(PELD)后复发现状及其危险因素。方法:回顾性分析2020年6月—2024年6月莆田市第一医院收治的238例LDH患者临床资料,均于院内行PELD,依据术后随访6个月是否复发进行分组,分为复发组14例,未复发组224例。通过单因素及多因素logistic回归分析确定影响患者术后复发LDH的相关因素。结果:单因素分析显示,性别、病程、疾病类型、体重指数、吸烟、饮酒、合并糖尿病、合并高血压、术中出血量、术后卧床时间、住院天数与LDH患者PELD术后复发无关,差异无统计学意义(P>0.05);年龄、从事高强度体力劳动、术中神经电生理监测、神经根损伤、纤维环破口大小、髓核摘除、术后椎间活动度、术后负重劳动与LDH患者PELD术后复发有关,差异有统计学意义(P<0.05)。将术后复发作为因变量,将年龄、从事高强度体力劳动、术中神经电生理监测、神经根损伤、纤维环破口大小、髓核摘除、术后椎间活动度、术后负重劳动作为可能影响术后复发腰椎间盘突出的因素进行赋值。多因素分析显示,神经根损伤、纤维环破口大小>5 mm、髓核摘除不彻底、术后椎间活动度>10°、术后负重劳动是影响LDH患者PELD术后复发的独立危险因素,差异有统计学意义(P<0.05)。结论:LDH患者PELD术后复发发生风险仍然较高,主要与纤维环破口大小、髓核摘除等因素有关,临床应注意采取相应措施进行干预,以降低术后复发风险。
Objective:To analyze the recurrence status and risk factors of patients with lumbar disc herniation(LDH)after percutaneous endoscopic lumbar discectomy(PELD).Method:A retrospective analysis was conducted on the clinical data of 238 LDH patients admitted to the First Hospital of Putian City from June 2020 to June 2024.All patients underwent PELD in the hospital and were divided into a recurrence group of 14 cases and a non recurrence group of 224 cases based on whether there was recurrence during the 6 months follow-up after surgery.The relevant factors affecting the recurrence of LDH in patients were determined through univariate and multivariate logistic regression analysis.Result:Univariate analysis showed that gender,course of disease,type of disease,body mass index,smoking,drinking,diabetes,hypertension,intraoperative bleeding,postoperative bed rest time,and hospital stay were not related to the relapse of LDH patients after PELD,and there were no significant differences(P>0.05).Age,high-intensity physical labor,intraoperative neurophysiological monitoring,nerve root injury,size of annulus fibrosus rupture,nucleus pulposus removal,postoperative intervertebral mobility,and postoperative weight-bearing labor were associated with postoperative recurrence of LDH in patients with PELD,and the differences were statistically significant(P<0.05).Postoperative recurrence was taken as the dependent variable,age,high-intensity physical labor,intraoperative neurophysiological monitoring,nerve root injury,size of annulus fibrosus rupture,nucleus pulposus removal,postoperative intervertebral mobility,and postoperative weight-bearing labor were assigned as factors that might affect postoperative recurrence of lumbar disc herniation.Multivariate analysis showed that nerve root injury,fibrous ring rupture size>5 mm,incomplete removal of the nucleus pulposus,postoperative intervertebral mobility>10°,and postoperative weight-bearing labor were independent risk factors for postoperative recurrence of PELD in LDH patients,with statistically significant differences(P<0.05).Conclusion:LDH patients still have a high risk of recurrence after PELD surgery,mainly related to factors such as the size of the annulus fibrosus rupture and nucleus pulposus removal.Clinical interventions should be taken accordingly to reduce the risk of postoperative recurrence.
作者
林卫挺
林建鑫
陈金国
LIN Weiting;LIN Jianxin;CHEN Jinguo(First Hospital of Putian City,Putian 351100,China;不详)
出处
《中外医学研究》
2025年第36期126-130,共5页
CHINESE AND FOREIGN MEDICAL RESEARCH
关键词
腰椎间盘突出症
经皮脊柱内镜下腰椎间盘切除术
术后复发
危险因素
干预措施
Lumbar disc herniation
Percutaneous endoscopic lumbar discectomy
Postoperative recurrence
Risk factors
Intervention measures
