经皮内窥镜下腰椎间盘切除术治疗腰椎间盘突出症术后再手术的危险因素分析

Risk factors of reoperations after percutaneous endoscopic lumbar discectomy for lumbar disc herniation

中文关键词:  腰椎间盘突出症  经皮内窥镜下腰椎间盘切除术  再手术  危险因素

英文关键词:Lumbar disc herniation  Percutaneous endoscopic lumbar discectomy  Reoperation  Risk factors

中文摘要:

  【摘要】 目的：探讨经皮内窥镜下腰椎间盘切除术（PELD）治疗腰椎间盘突出症（LDH）术后再手术的危险因素。方法：收集整理东南大学附属中大医院2014年7月~2017年6月因单节段LDH行PELD患者的临床资料，共计476例，根据是否再次手术分为再手术组（36例）和对照组（440例）。利用Kaplan-Meier评估法生成累计再手术率。观察两组年龄、性别、体重指数（BMI）、吸烟史、糖尿病史、病程、手术时间、手术医师、突出类型、椎间盘高度、手术及邻近节段椎间盘退变等级、椎间盘未突出部位钙化、Modic改变、腰椎失稳等临床参数，对上述参数做非配对t检验和卡方检验进行单因素分析，对有统计学意义（P<0.1）的因素进行多元Logistic回归分析。结果：初再次手术的时间间隔为12.2±10.3个月（1~48个月），63.9%的翻修手术（23例）在术后1年内进行，累计再手术率在4年时达到11.5%。再手术组与对照组在年龄≥50岁（52.8% vs 34.3%）、BMI≥24kg/m2（61.1% vs 43.9%）及腰椎失稳（47.2% vs 25.7%）、椎间盘未突出部位钙化（16.7% vs 33.6%）之间的差异有统计学差意义（P<0.1），性别、吸烟史、糖尿病史、手术医师、突出类型、椎间盘高度、Modic改变无统计学差异（P>0.1）。Logistic回归分析显示，再手术主要危险因素为：BMI≥24kg/m2（OR=2.41，95%CI为1.183~4.907，P<0.05），椎间盘未突出部位钙化（OR=0.33，95%CI为0.138~0.852，P<0.05）是再手术的保护性因素。结论：单节段LDH患者PELD术后再手术多发生于术后1年以内，BMI≥24kg/m2是导致PELD术后再手术的危险因素，而椎间盘未突出部位钙化可能是再手术的保护性因素。

英文摘要:

  【Abstract】 Objectives: To determine the risk factors of reoperation for lumbar disc herniation（LDH） after percutaneous endoscopic lumbar discectomy(PELD). Methods: 476 patients who underwent PELD for single-level LDH between July 2014 to June 2017 were enrolled in this study. All patients were divided into reoperation group and control group based on whether they accepted reoperations. The cumulative reoperation rate was evaluated by using Kaplan-Meier analysis. Surgical findings [age, sex, body mass index(BMI), smoking, diabetes, course of disease, operation time and surgeons] and clinical parameters (herniation type, Pfirrmann disc degeneration grade, Modic endplate changes, disc height, disk calcification, lumbar instability) were collected and retrospectively assessed. The above factors were compared between the two groups by using unpaired t test and Chi-Square test. Variables that were significant at the P<0.1 level were candidates for inclusion in the final multivariable Logistic regression analysis. Results: The mean interval between primary and revision surgeries was 12.2±10.3 months（1-48 months） and 63.9% of reoperations were performed within 1 year. Cumulative overall reoperation rate gradually increased to 11.5% in 4 years. Univariate analysis found that age ≥50, BMI≥24kg/m2, lumbar instability and unherniated disc calcification were statistically significant(P<0.1). However, the differences in gender, smoking, diabetes, surgeons herniation type, Modic endplate changes and disc height between the two groups were not significant(P>0.1). The Logistic regression analysis demonstrated BMI≥24kg/m2(OR=2.41, 95%CI 1.183-4.907, P<0.05) was a risk factor for reoperations after PELD while unherniated disc calcification(OR=0.33, 95%CI 0.138-0.852, P<0.05) was a protective factor. Conclusions: The reoperations after PELD for single level LDH mostly occurr within one year. BMI≥24kg/m2 is the risk factor for reoperations after PELD to treat LDH while unherniated disc calcification may be a protective factor.