腰椎间盘突出症术后复发的相关因素分析
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摘要
目的分析腰椎间盘突出症手术治疗后复发的相关因素,并探讨再手术治疗的方法,为改善患者预后积累经验。方法选取本院2008年1月~2014年12月接收的59例椎间盘摘除术后复发的腰椎间盘突出症患者为观察组;同期接收的348例行椎间盘摘除术后未复发患者为对照组。对两组患者临床资料进行回顾性分析,采用单因素及logistic回归多因素分析腰椎间盘突出症手术后复发的相关因素。将59例腰椎间盘突出症手术后复发患者采用随机数字法分为2组,A组(30例)采用全椎板切除术联合横突间植骨术,B组(29例)采用全椎板切除术联合椎弓根钉内固定术,比较两组优良率。结果单因素分析结果提示:年龄、病程、手术时间、术中出血量、手术节段是复发性腰椎间盘突出症的危险因素差异有统计学意义(P<0.05),而体重指数、高血压病史、糖尿病病史、椎间盘突出类型、椎间盘突出位置不是复发性腰椎间盘突出症的危险因素差异(P>0.05)。logistic多因素分析提示:年龄、病程、术中出血量、手术节段是复发性腰椎间盘突出症的危险因素(P<0.05),而手术时间不是复发性腰椎间盘突出症的危险因素差异无统计学意义(P>0.05)。A组治疗优良率为53.3%,B组为82.7%,两组的治疗优良率经过统计学处理,差异具有统计学意义(χ~2=5.848,P=0.025)。结论对于年龄≥50岁、病程≥4年的腰椎间盘突出症患者,应慎重选择手术治疗方法,对于复发性腰椎间盘突出症的高危患者,应该加强监护,对于再手术治疗患者,加强术前检查、术中操作,有助于改善患者预后。
Objective To analyze the related factors of recurrence after surgical treatment of lumbar disc herniation,explore the method of re operation treatment and improve the prognosis of patients with lumbar disc herniation.Methods 59 patients with recurrent lumbar disc herniation were selected.The patients with recurrent lumbar disc herniation were in the observation group,and 348 cases without recurrence were in the control group.The clinical data of the two groups were retrospectively analyzed,and the related factors of recurrence of lumbar disc herniation were analyzed by single factor and logistic regression analysis.59 cases with lumbar disc herniation after surgery recurrence patients with randomly divided into group A(30cases)by laminectomy with transverse process bone graft between and group B(29cases)by total laminectomy and pedicle screw internal fixation.The clinical effect was observed.Results The age,duration of disease,operative time,bleeding volume and operative segment were risk factors for recurrent lumbar disc herniation(P<0.05),and body mass index,history of hypertension,diabetes mellitus,disc herniation and lumbar disc herniation were not risk factors for recurrent lumbar disc herniation(P>0.05).Logistic multivariate analysis indicated that age,duration of disease,bleeding volume and operative segment were the risk factors for recurrent lumbar disc herniation(P<0.05),and the operative time was not a risk factor for recurrent lumbar disc herniation(P>0.05).The excellent and good rate of group A and group B were 53.3%and 82.7%(χ~2=5.848,P=0.025).Conclusion The surgical treatment should be carefully chosen for lumbar disc herniation patients with age over 50 years and duration more than or equal to 4years.The patients at high risk for recurrent lumbar disc herniation should strengthen monitoring and preoperative examination and operation,which can help to improve the prognosis of the patients.
Objective To analyze the related factors of recurrence after surgical treatment of lumbar disc herniation,explore the method of re operation treatment and improve the prognosis of patients with lumbar disc herniation.Methods 59 patients with recurrent lumbar disc herniation were selected.The patients with recurrent lumbar disc herniation were in the observation group,and 348 cases without recurrence were in the control group.The clinical data of the two groups were retrospectively analyzed,and the related factors of recurrence of lumbar disc herniation were analyzed by single factor and logistic regression analysis.59 cases with lumbar disc herniation after surgery recurrence patients with randomly divided into group A(30cases)by laminectomy with transverse process bone graft between and group B(29cases)by total laminectomy and pedicle screw internal fixation.The clinical effect was observed.Results The age,duration of disease,operative time,bleeding volume and operative segment were risk factors for recurrent lumbar disc herniation(P<0.05),and body mass index,history of hypertension,diabetes mellitus,disc herniation and lumbar disc herniation were not risk factors for recurrent lumbar disc herniation(P>0.05).Logistic multivariate analysis indicated that age,duration of disease,bleeding volume and operative segment were the risk factors for recurrent lumbar disc herniation(P<0.05),and the operative time was not a risk factor for recurrent lumbar disc herniation(P>0.05).The excellent and good rate of group A and group B were 53.3%and 82.7%(χ~2=5.848,P=0.025).Conclusion The surgical treatment should be carefully chosen for lumbar disc herniation patients with age over 50 years and duration more than or equal to 4years.The patients at high risk for recurrent lumbar disc herniation should strengthen monitoring and preoperative examination and operation,which can help to improve the prognosis of the patients.
引文
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[5]任士海,王鹏,赵伟,等.单侧与双侧椎弓根内固定治疗复发性腰椎间盘突出疗效比较[J].临床骨科杂志,2015,18(5):560-564.
[6]郑启新,邹枕玮,郭晓东,等.腰椎间盘退变性疾病的研究进展及展望[J].中华实验外科杂志,2010,27(11):1573-1576.
[7]王文军,薛静波,晏怡果,等.单侧微创经椎间孔腰椎椎体间融合内固定治疗腰椎退变性疾病[J].脊柱外科杂志,2012,10(01):9-12.
[8]曾佳兴,梁斌,尹东,等.青少年与中老年腰椎间盘突出相关因素分析[J].中国矫形外科杂志,2013,21(11):1121-1126.
[9]赵凤东,苏优乐图,倪东亮,等.小切口经腹膜外前路腰椎椎间融合术治疗复发性腰椎间盘突出症.中华骨科杂志[J].2014,34(03):258-264.
[10]何恩荣.微创手术联合补肾活血汤治疗腰椎间盘突出症疗效观察[J].河北中医,2015,37(07):1021-1023.
[11]刘宁.腰椎间盘突出复发相关因素分析及预防策略[J].现代诊断与治疗,2012,10(23):1753.
[12]毛克亚,王岩,肖嵩华,等.微创下腰椎经椎间孔椎体间融合术混合内固定治疗复发性腰椎间盘突出症的可行性研究[J].中华外科杂志,2013,51(08):723-727.
[13]周旭,贺石生,张海龙,等.新型腰椎经皮椎弓根螺钉植入定位方法及其对放射暴露剂量的影响[J].中华骨科杂志,2014,34(03):265-272.
[14]Suk KS,Lee HM,Moon SH,et al.Recurrent lumbar disc herniation:results of operative management[J].Spine 2011,26(6):672-676.
[15]胡文清,吕杭州,张仲,等.早期综合康复治疗预防腰椎间盘突出症术后症状复发的临床研究[J].中华物理医学与康复杂志,2010,32(11):860-862.
[16]董杰,陈博来,谭志宏,等.经皮椎间孔镜治疗腰椎间盘突出症临床疗效相关因素分析[J].中国中医骨伤科杂志,2015,23(7):26-29.
[17]林阳,陈安民,李锋,等.早期康复治疗对复发性腰椎间盘突出症再手术疗效的影响[J].中华物理医学与康复杂志,2013,35(1):33-36.
[18]车艳军,陈亮,杨惠林,等.复发性腰椎问盘突出症再手术的术式选择及疗效分析[J].中国脊柱脊髓杂志,2010,20(9):730-735.
[19]张志,高梁斌,李健,等.后路椎体间植骨融合椎弓根钉内固定治疗复发性腰椎间突出症[J].中华生物医学工程杂志,2010,16(2):167-170.
[20]张伟,陈德玉,杨立利,等.复发性腰椎间盘突出症两种术式的选择及疗效分析[J].中国矫形外科杂志,2013,21(9):883-886.
[2]孙正明,凌鸣,常彦海,等.北方五省腰椎间盘突出症危险因素研究[J].南方医科大学学报,2010,30(11):2488-2491.
[3]孟繁星,彭嘉斌.腰椎间盘突出症单纯髓核摘除术术后复发的相关因素研究[J].总装备部医学学报,2014,16(1):10-13.
[4]陈新用,梁裕,曹鹏,等.手术治疗腰椎间盘突出症的长期疗效及其影响因素[J].中国脊柱脊髓杂志,2012,22(8):717-721.
[5]任士海,王鹏,赵伟,等.单侧与双侧椎弓根内固定治疗复发性腰椎间盘突出疗效比较[J].临床骨科杂志,2015,18(5):560-564.
[6]郑启新,邹枕玮,郭晓东,等.腰椎间盘退变性疾病的研究进展及展望[J].中华实验外科杂志,2010,27(11):1573-1576.
[7]王文军,薛静波,晏怡果,等.单侧微创经椎间孔腰椎椎体间融合内固定治疗腰椎退变性疾病[J].脊柱外科杂志,2012,10(01):9-12.
[8]曾佳兴,梁斌,尹东,等.青少年与中老年腰椎间盘突出相关因素分析[J].中国矫形外科杂志,2013,21(11):1121-1126.
[9]赵凤东,苏优乐图,倪东亮,等.小切口经腹膜外前路腰椎椎间融合术治疗复发性腰椎间盘突出症.中华骨科杂志[J].2014,34(03):258-264.
[10]何恩荣.微创手术联合补肾活血汤治疗腰椎间盘突出症疗效观察[J].河北中医,2015,37(07):1021-1023.
[11]刘宁.腰椎间盘突出复发相关因素分析及预防策略[J].现代诊断与治疗,2012,10(23):1753.
[12]毛克亚,王岩,肖嵩华,等.微创下腰椎经椎间孔椎体间融合术混合内固定治疗复发性腰椎间盘突出症的可行性研究[J].中华外科杂志,2013,51(08):723-727.
[13]周旭,贺石生,张海龙,等.新型腰椎经皮椎弓根螺钉植入定位方法及其对放射暴露剂量的影响[J].中华骨科杂志,2014,34(03):265-272.
[14]Suk KS,Lee HM,Moon SH,et al.Recurrent lumbar disc herniation:results of operative management[J].Spine 2011,26(6):672-676.
[15]胡文清,吕杭州,张仲,等.早期综合康复治疗预防腰椎间盘突出症术后症状复发的临床研究[J].中华物理医学与康复杂志,2010,32(11):860-862.
[16]董杰,陈博来,谭志宏,等.经皮椎间孔镜治疗腰椎间盘突出症临床疗效相关因素分析[J].中国中医骨伤科杂志,2015,23(7):26-29.
[17]林阳,陈安民,李锋,等.早期康复治疗对复发性腰椎间盘突出症再手术疗效的影响[J].中华物理医学与康复杂志,2013,35(1):33-36.
[18]车艳军,陈亮,杨惠林,等.复发性腰椎问盘突出症再手术的术式选择及疗效分析[J].中国脊柱脊髓杂志,2010,20(9):730-735.
[19]张志,高梁斌,李健,等.后路椎体间植骨融合椎弓根钉内固定治疗复发性腰椎间突出症[J].中华生物医学工程杂志,2010,16(2):167-170.
[20]张伟,陈德玉,杨立利,等.复发性腰椎间盘突出症两种术式的选择及疗效分析[J].中国矫形外科杂志,2013,21(9):883-886.