Characterization and Risk Factor Analysis for Reoperation After Microendoscopic Diskectomy
Characterization and Risk Factor Analysis for Reoperation After Microendoscopic Diskectomy
复制标题
显微内镜椎间盘切除术后再次手术的特征和危险因素分析
DOI：
10.3928/01477447-20150603-57
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发表时间：
2015-06-01
期刊：
影响因子：
1.1
通讯作者：
Wu, Xiaotao
中科院分区：
文献类型：
--
作者：
Hong, Xin;Liu, Lei;Wu, Xiaotao
回顾性分析了2005年至2010年间1263例连续行单节段腰椎间盘突出显微内镜椎间盘切除术患者的人群数据库，以确定再次手术的原因、特征和相关危险因素。共有952名患者符合条件。其中，58人接受了脊柱翻修手术。回顾性评估病因和临床参数，并通过多因素logistic回归分析评估可能的危险因素。总共有76例椎间盘突出通过改良椎间盘切除术切除，伴或不伴椎间融合。初次手术和翻修手术之间的总体平均间隔为39.05个月（范围2-95个月）。累计整体再手术率从1年的1.56%逐渐上升到近10年的8.17%。再手术患者年龄较大，腰椎退变程度较高，伴有严重的Modic改变（1型，17.2%；2型，34.5%），而非再手术患者（1型，1.5%；2型，30.6%）。此外，再次手术患者明显邻近椎间盘退变率较高（81.1%）。Logistic回归分析显示，相邻节段退变和椎间盘退变Pfirrmann分级是初次显微内镜椎间盘切除术后再次手术的重要危险因素（优势比分别为2.448和1.510）。目前的研究报告了初次显微内镜椎间盘切除术后再手术的发生率相对较低。邻段退变和椎间盘退变的Pfirrmann分级被认为是显微内镜下腰椎间盘切除术治疗腰椎间盘突出症后再手术的危险因素。在首次就诊时应仔细评估有这些因素的患者的治疗方案。
A population-based database of 1263 consecutive patients who underwent microendoscopic diskectomy for single-level lumbar disk herniation between 2005 and 2010 was retrospectively analyzed to identify causes and characteristics of reoperation and associated risk factors. A total of 952 patients were eligible. Of these, 58 had revision spinal surgery. Causes and clinical parameters were retrospectively assessed, and possible risk factors were evaluated by multivariate logistic regression analysis. In total, 76 disk herniations were excised with revision diskectomy, with or without interbody fusion. The overall mean interval between primary surgery and revision surgery was 39.05 months (range, 2-95 months). Cumulative overall reoperation rates gradually increased from 1.56% at 1 year to 8.17% after nearly 10 years. Reoperated patients were older and had a higher level of lumbar degeneration, with severe Modic changes (type 1, 17.2%; type 2, 34.5%), vs patients without reoperation (type 1, 1.5%; type 2, 30.6%). In addition, patients with reoperation had a higher rate of obvious adjacent disk degeneration (81.1%). Logistic regression analysis showed that adjacent segment degeneration and Pfirrmann grading for disk degeneration were significant risk factors for reoperation after primary microendoscopic diskectomy (odds ratios, 2.448 and 1.510, respectively). The current study reported a relatively low incidence of reoperation after primary microendoscopic diskectomy. Adjacent segment degeneration and Pfirrmann grading for disk degeneration were identified as risk factors for reoperation after microendoscopic diskectomy to treat lumbar disk herniation. Treatment options for patients with these factors at the first visit should be carefully evaluated.