【作者】 许刚；

【导师】 张达颖；

【作者基本信息】 南昌大学 ， 麻醉学（专业学位）， 2020， 硕士

【摘要】 目的:探讨经椎间孔入路脊柱内镜治疗腰椎间盘突出(Lumbar Disc Herniation,LDH)疗效的相关危险因素,为临床应用提供参考。方法:收集并整理2016年1月至2018年9月于南昌大学第一附属医院疼痛科行经皮内镜椎间孔髓核切除术(Percutaneous Endoscopic Transforaminal Discectomy,PETD)治疗的458例LDH患者的临床资料,其中排除患者33例,对425例LDH患者进行术后1年随访,随访的患者中男性患者257例,女性患者168例,年龄16-79岁。采用改良MacNab疗效评价标准评价手术疗效并进行分组,改良MacNab标准评价优、良者为G组(389例),改良MacNab标准评价可、差的患者为B组(36例)。对两组患者年龄、性别、BMI、吸烟、腰椎外伤史、病程、根性疼痛是否合并腰痛、节段、Pfirrmann分级、椎管形态、突出物钙化及腰椎滑脱等临床参数做卡方检验进行单因素分析,对单因素分析中有统计学意义(P<0.05)的因素行Logistic回归分析。结果:单因素分析结果显示两组患者在性别、吸烟史、腰椎外伤史、节段、根性疼痛是否合并腰痛方面比较无统计学意义(P>0.05);两组在患者BMI、年龄、病程、椎管形态、Pfirrmann分级、腰椎滑脱及突出物钙化方面比较有统计学意义(P<0.05)。Logistic多因素分析结果显示患者年龄、椎管形态、Pfirrmann分级不是影响PETD治疗LDH疗效的危险因素(P>0.05),病程(OR=8.505,P=0.002)、BMI(OR=7.334,P<0.001)、腰椎滑脱(OR=15.072,P=0.001)、突出物钙化(OR=27.613,P<0.001)是影响PETD治疗LDH疗效的危险因素。结论:BMI、年龄、病程、椎管形态、Pfirrmann分级、腰椎滑脱及突出物钙化与PETD治疗LDH的疗效有关,其中病程、BMI、腰椎滑脱、突出物钙化为影响PETD治疗LDH疗效的独立危险因素。更多还原

【Abstract】 Objective To explore the risk factors related to the efficacy of transforaminal spinal endoscopy in the treatment of lumbar disc herniation(LDH),and to provide a reference for clinical application.Methods The clinical data of 458 patients with LDH who underwent percutaneous endoscopic transforaminal discectomy(PETD)in the Department of Pain of the First Affiliated Hospital of Nanchang University from January 2016 to September 2018 were collected and organized.33 patients were excluded,and 425 patients with LDH were followed up for 1 year.The patients followed up were 257 male patients and 168 female patients,aged 16-79 years.The modified MacNab curative effect evaluation criteria were used to evaluate the curative effect of the surgery and grouped.The patients with modified MacNab evaluation standard excellent and good were group G(389 patients),and those with modified MacNab evaluation standard medium and poor were group B(36 patients).Chi-square test was used to perform single factor analysis on clinical parameters such as age,gender,BMI,smoking,history of lumbar trauma,course of the disease,whether radiculalgia merges back pain,segments,Pfirrmann classification,spinal canal morphology,protrusion calcification,and spondylolisthesis.Logistic regression analysis was performed for those factors that had statistical significance(P<0.05)in univariate analysis.Results The results of univariate analysis showed that the two groups of patients were not statistically significant in terms of gender,smoking history,lumbar trauma history,segment,and whether radiculalgia merges back pain(P>0.05);the two groups were compared in terms of BMI,age,course of disease,spinal canal shape,Pfirrmann classification,spondylolisthesis,and calcification of protrusions were statistically significant(P<0.05).Logistic multivariate analysis showed that patient age,spinal canal morphology,and Pfirrmann classification were not risk factors affecting the efficacy of PETD in the treatment of LDH(P>0.05),course of the disease(OR = 8.505,P = 0.002),BMI(OR = 7.334,P<0.001),spondylolisthesis(OR = 15.072,P = 0.001),protrusion calcification(OR=27.613,P<0.001)are the risk factors affecting the efficacy of PETD in the treatment of LDH.Conclusion BMI,age,course of disease,spinal canal morphology,Pfirrmann classification,spondylolisthesis,and calcification of protrusions are related to the efficacy of PETD in the treatment of LDH.The course of disease,BMI,spondylolisthesis and calcification of protrusions affect PETD in the treatment of LDH Independent risk factors for efficacy.更多还原