椎间孔镜腰椎间盘切除术后早期复发的相关因素△

Factors associated with early recurrent lumbar disc herniation after percutaneous transforaminal endoscopic discectomy

摘要:

［目的］分析经皮椎间孔镜腰椎间盘摘除术（percutaneous transforaminal endoscopic discectomy, PTED）治疗腰椎间盘突出症术后早期复发的相关因素。［方法］对 2017 年 1 月—2019 年 12 月经 PTED 治疗的单节段腰椎间盘突出症 285 例患者的临床资料进行回顾性分析，根据术后是否早期复发将患者分为两组，采用单项因素比较和二元多因素逻辑回归分析早期复发的相关因素。［结果］285 例患者平均随访（12.64±6.51）个月，其中，19 例患者在术后 6 个月内复发，早期复发率为 6.67%，平均复发时间 （73.53±49.66）d。单因素比较表明，与非早期复发组相比，早期复发组的椎间盘退变程度 Pfirrmann 分级显著更重（P<0.05），突出部位显著更偏外侧（P<0.05），Modic 改变显著更重（P<0.05），椎间盘高度指数显著更小（P<0.05），突出物基底部宽度显著更大 （P<0.05），术后纤维环破口显著更大 （P<0.05），椎间孔面积显著更小 （P<0.05）。逻辑回归表明：突出基底部宽度大 （OR= 1.368，P<0.05），Modic 改变重（OR=1.761, P<0.05）是早期复发的独立危险因素，而椎间孔面积大（OR=0.947，P<0.05）是保护因素。［结论］ 椎间盘高度指数小、椎间盘退变程度重、术后纤维环破口大、椎间盘突出部位偏外可能与术后早期复发相关、突出基底部宽度大、Modic 改变重是 PTED 术后早期复发的相关危险因素，而椎间孔面积大是 PTED 术后早期复发的保护因素。

Abstract:

[Objective] To search the factors related to early postoperative recurrence of lumbar disc herniation (LDH) secondary to per- cutaneous transforaminal endoscopic discectomy (PTED) . [Methods] A retrospective study was performed on 285 patients who received PT- ED for single-segment lumbar disc herniation from January 2017 to December 2019. The patients were divided into two groups according to whether the patients had early recurrent LDH after surgery, and the factors related to early recurrence were analyzed by univariate compari- son and binary multiple logistic regression. [Results] All the 285 patients were followed up for (12.64± 6.51) months on an average. Of them, 19 patients were definitively diagnosed of recurrent LDH within 6 months after operation, accounting for 6.67% with recurrence time of (73.53± 49.66) days on a mean. As results of univariate comparisons, the recurrent group had significantly more severer extent of disc degen- eration in Pfirrmann grade (P＜0.05) , more lateral protrusion (P＜0.05) , more severe Modic changes (P＜0.05) , lower intervertebral disc height index (P＜0.05) , greater width protrusion base (P＜0.05) , larger postoperative annular fibrous defect (P＜0.05) , whereas smaller inter- vertebral foramen area (P＜0.05) than the non-recurrent group. In term of logistic regression, the large width protrusion base (OR=1.368, P＜ 0.05) and severe Modic change (OR=1.761, P＜0.05) were of independent risk factors for early recurrence, while the large intervertebral fo- raminal area (OR=0.947, P＜0.05) was of a protective factor. [Conclusion] The small intervertebral disc height index, severe degree of inter- vertebral disc degeneration, large postoperative annulus fibrosus defect, more lateral protrusion site, large width of the protrusion base, and severe Modic change might be the risk factors, while large foraminal area be a protective factor for early recurrence after PTED.