单纯髓核摘除术治疗腰椎间盘突出症术后复发的多元影响因素分析

摘要

目的 研究导致腰椎间盘突出症单纯髓核摘除术术后复发的多元影响因素.方法 选取2013年4月至2016年5月,于我院接受单纯椎间盘髓核摘除术的181例L5~S1节段椎间盘突出患者作为研究对象,将其分为复发组和非复发组,并对两组的临床参数(年龄、性别、体质量指数),症状持续时间、糖尿病、吸烟、突出类型、术前疼痛视觉模拟评分(visual analogue scale,VAS)及术前影像学参数[椎间盘退变、椎间盘高度指数(disc heigh index,DHI)和矢状面活动度(sagittal range of motion,sROM)]进行比较.使用F检验对临床和X线参数进行单因素分析.使用配对t检验比较两组连续性数据的均值.单因素分析时任何P≤0.5的变量均被纳入到多元Logistic回归模型中.根据多元Logistic回归分析,确认腰椎间盘突出症术后复发(postoperative recurrent lumber disc herniation,PRLDH)相关的独立的危险因素.结果 两组年龄、性别、吸烟、椎间盘退变、DHI及sROM差异有统计学意义(P<0.05).多元Logistic回归分析表明,年龄(R2=0.641,P=0.013)、吸烟(R2=0.595,P=0.022)、椎间盘退变(B组)(R2=0.683,P=0.012),DHI(R2=0.536,P=0.028)和sROM(R2=0.792,P<0.001)是PRLDH的独立危险因素,而性别(R2=0.263,P=0.236)是相对独立危险因素.结论 年龄、吸烟、椎间盘退变、DHI和sROM均为PRLDH的危险因素,而sROM是最危险因素.%Objective To study the multiple factors affecting the postoperative recurrence of lumbar disc herniation after lumbar discectomy. Methods From April 2013 to May 2016, 181 L5 - S1 disc herniation patients were treated with lumbar discectomy. All patients were divided into recurrent and non-recurrent groups. Clinical parameters ( age, gender and body mass index ), duration of symptoms, diabetes, smoking, disc herniation type, preoperative visual analogue scale ( VAS ) and preoperative radiological parameters [ intervertebral disc degeneration, intervertebral disc height and sagittal range of motion ( sROM ) ] were compared. The clinical and X-ray parameters were analyzed by F test. Paired t-test was used to compare the mean value of the continuous data between the 2 groups. Any variable ≤ 0.5 in single factor analysis was included in the multivariate Logistic regression model. Based on the multivariate Logistic analysis, the independent risk factors associated with postoperative recurrent lumber disc herniation ( PRLDH ) were confirmed. Results Age, gender, smoking, intervertebral disc degeneration, intervertebral disc height and sROM were significantly different between the 2 groups ( P < 0.05 ). Results of Logistic regression analysis: age ( R2 =0.641, P = 0.013 ), smoking ( R2 = 0.595, P = 0.022 ), intervertebral disc degeneration ( Group B ) ( R2 = 0.683, P =0.012 ), intervertebral disc height ( R2 = 0.536, P = 0.028 ) and sROM ( R2 = 0.792, P < 0.001 ) were all risk factors of PRLDH. Gender ( R2 = 0.263, P = 0.236 ) was a relative risk factor. Conclusions Age, smoking, intervertebral disc degeneration, intervertebral disc height index and sROM were the risk factors for the PRLDH, while the sROM was the most risky factor of all.