【摘要】 目的:探讨经皮椎间孔镜与椎间盘镜髓核摘除术治疗腰椎间盘突出症(LDH)的疗效及术后复发影响因素。方法:选取2017年3月至2019年3月间本院收治的120例LDH患者为研究对象,采用随机数字表经简单随机分组方法分为A、B组,每组60例。A组患者接受经皮椎间孔镜治疗,B组患者接受椎间盘镜髓核摘除术治疗。记录并比较两组患者的围术期指标,术后随访1年,比较两组患者随访期间的视觉模拟评分(VAS)、腰椎Oswestry功能障碍指数(ODI)变化,并采用改良MacNab标准评估两组患者的疗效。末次随访时根据患者的复发情况分为复发组(17例)、未复发组(103)例,采用单因素分析、多因素Logistic回归分析LDH患者复发的影响因素。结果:A组患者的手术时间大于B组患者,而术中出血量、切口长度、住院时间等均小于B组患者,差异具有统计学意义(P<0.05)。患者的VAS评分、ODI指数随时间增长均呈显著下降趋势(P<0.0.5)。A组患者的临床疗效优良率高于B组患者,但差异无统计学意义(P>0.05)。单因素分析显示,年龄、病程、疾病类型、退变程度分级、手术节段、术中纤维环破损、术中髓核摘除不彻底等可能为LDH患者术后复发的影响因素(P<0.05),而性别、BMI、吸烟史、饮酒史、合并症、手术方式、手术时间、突出位置等均与LDH患者术后复发无关(P>0.05)。多因素Logistic回归分析显示,年龄<60岁、病程<3年、脱出型LDH为术后复发的独立保护因素(P<0.05),L4～L5、L5～S1手术节段、术中纤维环破损、术中髓核摘除不彻底等为术后复发的独立危险因素(P<0.05),而退变程度分级与术后复发无关(P>0.05)。结论:经皮椎间孔镜与椎间盘镜髓核摘除术均可有效治疗腰椎间盘突出症,而在术后复发患者中,年龄、病程、疾病类型、手术节段、术中纤维环破损、术中髓核摘除不彻底等为主要影响因素,临床中针对存在以上危险因素患者需予以积极干预以降低术后复发率。更多还原

【Abstract】 Objective:To explore the efficacy of percutaneous foraminal endoscopy and disc endoscopic nucleus pulposus in the treatment of lumbar disc herniation(LDH) and the factors affecting postoperative recurrence.Methods:120 patients with LDH admitted to our hospital from March 2017 to March 2019 were selected as the research objects,and they were divided into groups A and B by simple random grouping method,with 60 cases in each group.Patients in group A underwent percutaneous transforaminal endoscopy,and patients in group B underwent endoscopic discectomy.The perioperative indicators of patients were recorded and compared,the visual analogue score(VAS) and the changes of the lumbar Oswestry dysfunction index(ODI)during the one year follow-up period were compared,and the modified MacNab standard was used to evaluate the efficacy of the two groups.At the last follow-up interview,patients were divided into recurrence group(17 cases) and non-recurrence group(103) according to their recurrence status.Single factor analysis and multivariate logistic regression were used to analyze the influencing factors of LDH patients’ recurrence.Results:The operation time of group A was longer than that of group B,and the amount of intraoperative blood loss,incision length,and hospital stay of group A were shorter than those of group B.The difference was statistically significant(P<0.05).The patients’ VAS score and ODI index showed a significant downward trend over time(P<0.05).The clinical efficacy rate of patients in group A was higher than that in group B,but the difference was not statistically significant(P>0.05).Univariate analysis showed that age,course of disease,type of disease,grade of degeneration,operative segment,intraoperative fibrous annulus damage,intraoperative incomplete removal of nucleus pulposus,etc.may be factors influencing postoperative recurrence of LDH patients(P<0.05),And gender,BMI,history of smoking,history of drinking,comorbidities,operation method,operation time,prominent position,etc.were not related to postoperative recurrence of LDH patients(P>0.05).Multivariate logistic regression analysis showed that age<60 years,course of disease<3 years,and extracted LDH were independent protective factors for postoperative recurrence(P<0.05),L4 ～ L5,L5 ～ S1 surgical segment,intraoperative fibroblast damage,intraoperative incomplete removal of nucleus pulposus were independent risk factors for postoperative recurrence(P<0.05),and the degree of degeneration was not related to postoperative recurrence(P>0.05).Conclusion:Both percutaneous foraminal endoscopy and discectomy nucleus pulposus can effectively treat lumbar disc herniation.In patients with recurrence after surgery,age,disease course,disease type,surgical segment,intraoperative annulus fibrosus damage,intraoperative incomplete removal of nucleus pulposus are the main influencing factors.Patients with the above risk factors need to be actively intervened to reduce the recurrence rate after surgery.更多还原