方法:回顾性研究。
目的:分析TELD治疗腰椎间盘突出症术后早期复发的原因及影响因素。
方法:我们纳入了2017年1月至2019年12月在南华大学附属第一医院使用经椎间孔镜腰椎髓核摘除术治疗的285例单节段腰椎间盘突出症患者。根据临床症状和MRI复查将患者分为早期复发和非早期复发组。成像数据(例如,圆盘高度指数(DHI),Pfirrman成绩,基底宽度,术后纤维环撕裂大小,孔的横截面积(CSAF),等。)进行了分析,和多变量,采用二项逻辑回归分析确定哪些因素与TELD术后早期复发相关.
结果:共有285例患者完成了手术和临床随访,其中19例患者在术后6个月内复发,早期复发率为6.7%。DHI之间的差异有统计学意义,Pfirrman成绩,基底宽度,术后纤维环撕裂大小,疝部位,早期复发组和非早期复发组之间的CSAF和Modic变化(P<0.05)。在多元逻辑回归中,椎间盘退变程度(OR=.747,P=.037),CSAF(OR=5.255,P=.006),Modic改变程度(OR=1.831,P=.018)和疝的基底宽度(OR=4.942,P=.003)与TELD后早期复发显着相关。
结论:术后纤维环撕裂大小,DHI,椎间盘突出的位置与TELD术后早期复发有关。增加了疝的底部宽度,严重椎间盘退变,CSAF降低和Modic改变是TELD术后早期复发的危险因素。
METHODS: Retrospective study.
OBJECTIVE: To analyze the causes of and factors influencing early recurrence after TELD performed in the treatment of lumbar disc herniation.
METHODS: We included 285 patients with single-segment lumbar disc herniation treated using transforaminal endoscopy lumbar discectomy TELD from January 2017 to December 2019 at the First Affiliated Hospital of the University of South China. Patients were classified into early recurrence and non-early recurrence groups based on clinical symptoms and MRI reexamination. Imaging data (eg, disc height index (DHI), Pfirrman grades, base width, postoperative annulus-fibrosus tear size, cross-sectional area of the foramen (CSAF), etc.)were analyzed, and multivariate, binomial logistic regression was utilized to determine which factors were associated with early recurrence after TELD.
RESULTS: A total of 285 patients completed surgery and clinical follow-up, during which 19 patients relapsed within 6 months postsurgery, for an early recurrence rate of 6.7%. There were statistically significant differences between DHI, Pfirrman grades, base width, postoperative annulus-fibrosus tear size, herniation sites, CSAF and Modic changes between the early recurrence and non-early recurrence groups (P < .05). On multivariate logistic regression,the degree of disc degeneration (OR = .747, P = .037), CSAF (OR = 5.255, P = .006), degree of Modic change (OR = 1.831, P = .018) and base width of the herniation (OR = 4.942, P = .003) were significantly correlated with early recurrence after TELD.
CONCLUSIONS: Postoperative annulus-fibrosus tear size, DHI, and location of the disc herniation were associated with early recurrence after TELD. Increased base width of the herniation, severe disc degeneration, decreased CSAF and Modic change were risk factors for early recurrence after TELD.