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

doi:10.3969/j.issn.1006-6233.2021.03.016

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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.

Key words： Percutaneous foraminal endoscopy Discectomy nucleus pulposus Lumbar disc herniation Clinical efficacy Postoperative recurrence Influencing factors

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2021.03.016 OR http://www.hbyxzzs.cn/EN/Y2021/V27/I3/429

[1] 郁凯,杨忠,李爱民,等.经皮椎间孔镜下髓核摘除术和显微镜下髓核摘除术治疗腰椎间盘突出症的疗效比较[J].中国全科医学,2018,21(z1):20~22.
[2] 邵礼晖,潘浩.经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症疗效观察[J].浙江临床医学,2020,22(1):141~142.
[3] 吴坤懂,张慧森,刘凯恒,等.经皮椎板间入路与经皮椎间孔入路椎间孔镜下髓核摘除术治疗腰椎间盘突出症疗效比较[J].中国临床医生杂志,2019,47(9):1068~1071.
[4] 唐谨,刘缪,李莹,等.腰椎间盘突出症椎间孔镜术后复发的原因分析及相关预防对策[J]中国中医骨伤科杂志,2017,25(2):75~78.
[5] 齐文斌,朱彦海.经皮椎间孔镜手术治疗腰椎间盘突出症的疗效观察及术后复发的相关因素分析[J].颈腰痛杂志,2019,40(6):776~780.
[6] Gu YT,Cui Z,Shao HW,et al.Percutaneous transforaminal endoscopic surgery (PTES) for symptomatic lumbar disc herniation:a surgical technique,outcome,and complications in 209 consecutive cases[J].Orthop Surg Res,2017,12(1):25~38.
[7] 赵晓明,刘亮,袁启令,等.椎间孔镜与椎间盘镜治疗腰椎间盘突出症后复发率及翻修率比较的Meta分析[J].中国内镜杂志,2019,25(12):1~8.
[8] Jiang XJ,Zhou XD,Xu NW.Clinical effects of transforaminal and interlaminar percutaneous endoscopic discectomy for lumbar disc herniation:A retrospective study.[J].Medicine (Baltimore),2018,97(48):e13417.
[9] 侯辉宝,张力人,李国强,等.经皮椎间孔镜下髓核摘除术与小切口椎板间开窗髓核摘除术治疗腰椎间盘突出症患者的对比研究[J].河北医学,2019,25(5):828~834.
[10] Chen Z,Zhang LM,Dong JW,et al.Percutaneous transforaminal endoscopic discectomy compared with microendoscopic discectomy for lumbar disc herniation:1-year results of an ongoing randomized controlled trial[J].Neurosurg Spine,2018,28(3):300~310.
[11] Shin EH,Cho KJ,Kim YT,et al.Risk factors for recurrent lumbar disc herniation afterdiscectomy[J].Int Orthop,2019,43(16):963~967.
[12] 梁智林,海涌,杨晋才,等.经皮椎间孔镜治疗腰椎间盘突出症术后复发影响因素研究[J].中国骨与关节杂志,2020,9(1):5~10.