The Effect of Percutaneous Intervertebral Foraminal Endoscopy and Disc Endoscopic Nucleus Excision in the Treatment of Lumbar Disc Herniation and Analysis of Influencing Factors for Recurrence
ZHU Hao, LIU Bo, ZHANG Huayi, et al
Leshan People's Hospital, Sichuan Leshan 614000, China
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.
朱灏, 刘波, 张华溢, 张智, 刘煊文. 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的疗效及复发影响因素分析[J]. 河北医学, 2021, 27(3): 429-436.
ZHU Hao, LIU Bo, ZHANG Huayi, et al. The Effect of Percutaneous Intervertebral Foraminal Endoscopy and Disc Endoscopic Nucleus Excision in the Treatment of Lumbar Disc Herniation and Analysis of Influencing Factors for Recurrence. HeBei Med, 2021, 27(3): 429-436.
2021, Vol. 27 
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