Risk Factors for Recurrent L4-5 Disc Herniation After Percutaneous Endoscopic Transforaminal Discectomy: A Retrospective Analysis of 654 Cases.
Risk Factors for Recurrent L4-5 Disc Herniation After Percutaneous Endoscopic Transforaminal Discectomy: A Retrospective Analysis of 654 Cases.
复制标题
经皮内镜椎间孔椎间孔切除术后L4-5椎间盘突出症复发的危险因素：654例的回顾性分析
DOI：
10.2147/rmhp.s287976
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发表时间：
2020
影响因子：
3.5
通讯作者：
Ma X
中科院分区：
文献类型：
--
作者：
Kong M;Xu D;Gao C;Zhu K;Han S;Zhang H;Zhou C;Ma X
经皮内窥镜腰椎间盘切除术（PELD）是一种越来越多应用的微创手术，在治疗腰椎间盘突出症（LDH）方面有几个优点。然而，复发性LDH （rLDH）已成为一个令人担忧的术后并发症。关于rLDH的危险因素，仍然很难达成共识并得出可靠的结论。目的：本回顾性研究旨在探讨经皮内窥镜椎间孔椎间盘切除术（PETD）后L4-5水平发生rLDH的相关危险因素。方法选取2013年10月至2020年1月在L4-5节段行PETD手术的654例患者，分为复发组（n=46）和非复发组（n=608）。收集人口统计学、临床资料及影像学参数，采用单变量和多元回归分析。结果目前的研究发现，成功的PETD后L4/5水平的rLDH发生率为7%。单因素分析显示，年龄较大、BMI高、糖尿病史、吸烟、大负荷强度、中度椎间盘退变、小肌盘比（M/D）、较多脂肪浸润、大矢状关节活动度（sROM）、脊柱侧弯、小椎间盘高度指数（DHI）、小椎间隙角（ISA）、小腰椎前凸（LL）是l4 ~ 5级PETD术后LDH复发的潜在危险因素（P < 0.10）。多因素分析提示，高BMI、大负荷强度、中度椎间盘退变、小M/D、较多脂肪浸润、大sROM、小ISA、小LL是PETD术后LDH复发的独立显著危险因素。结论术前考虑椎间盘退变、M/D、椎旁肌肉脂肪浸润、rom、ISA、LL、BMI和体力负荷强度，有助于预防PETD后rLDH的发生，使手术效果更满意，出院后制定合理的康复计划。
Background Percutaneous endoscopic lumbar discectomy (PELD) is an increasingly applied minimally invasive procedure that has several advantages in the treatment of lumbar disc herniation (LDH). However, recurrent LDH (rLDH) has become a concerning postoperative complication. It remains difficult to establish a consensus and draw reliable conclusions regarding the risk factors for rLDH. Purpose This retrospective study aimed to investigate the risk factors associated with rLDH at the L4-5 level after percutaneous endoscopic transforaminal discectomy (PETD). Methods A total of 654 patients who underwent the PETD procedure at the L4-5 level from October 2013 to January 2020 were divided into a recurrence (R) group (n=46) and a nonrecurrence (N) group (n=608). Demographic and clinical data and imaging parameters were collected and analyzed using univariate and multiple regression analyses. Results The current study found a 7% rate of rLDH at the L4/5 level after successful PETD. Univariate analysis showed that older age, high BMI, diabetes mellitus history, smoking, large physical load intensity, moderate disc degeneration, small muscle–disc ratio (M/D), more fat infiltration, large sagittal range of motion (sROM), scoliosis, small disc height index (DHI), small intervertebral space angle (ISA), and small lumbar lordosis (LL) were potential risk factors (P < 0.10) for LDH recurrence after PETD at the L4-5 level. Multivariate analysis suggested that high BMI, large physical load intensity, moderate disc degeneration, small M/D, more fat infiltration, large sROM, small ISA, and small LL were independent significant risk factors for recurrence of LDH after PETD. Conclusion Consideration of disc degeneration, M/D, fat infiltration of the paravertebral muscles, sROM, ISA, LL, BMI, and physical load intensity prior to surgical intervention may contribute to the prevention of rLDH following PETD and lead to a more satisfactory operative outcome and the development of a reasonable rehabilitation program after discharge.