影响腰椎间盘突出症患者经皮椎间孔镜下椎间盘切除术治疗效果的相关因素分析

Associated factors affecting the therapeutic effect of percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation

摘要:

目的 分析影响腰椎间盘突出症（LDH）患者经皮椎间孔镜下椎间盘切除术（PTED）治疗效果的相关因素。方法 纳入2019年3月－2022年8月该院骨伤科收治的310例LDH患者，均接受PTED治疗，回顾性分析患者的临床资料。患者均完成1年随访，疗效优良的患者259例，纳入优良组，疗效可和差的患者51例，纳入非优良组。通过单因素分析及多因素Logistic回归模型，分析影响LDH患者PTED治疗效果的相关因素。结果 310例LDH患者，均接受PTED治疗，随访1年，疗效优良259例，优良率为83.55%。与优良组比较，非优良组年龄 > 50岁、腰腿痛、病程 > 1年、侧隐窝狭窄、纤维环破裂、Modic改变、工作模式（负重或长期固定姿势）、椎间盘退变Pfirrmann分级Ⅲ级至Ⅳ级比例更高（P < 0.05）。多因素Logistic回归分析结果显示：年龄 > 50岁（OR＾ = 1.022，95%CI：1.006~1.038）、腰腿痛（OR＾ = 1.059，95%CI：1.036 ~ 1.081）、侧隐窝狭窄（OR＾ = 1.069，95%CI：1.020~1.120）、工作模式为负重或长期固定姿势（OR＾ = 1.064，95%CI：1.025 ~ 1.104），是导致LDH患者PTED治疗效果不良的危险因素（P < 0.05）。结论 LDH患者经PTED治疗后随访1年，疗效优良率为83.55%，影响疗效的因素较多，包括：年龄 > 50岁、腰腿痛、侧隐窝狭窄和工作模式为负重或长期固定姿势，临床可据此采取相应的干预措施。

Abstract:

Objective To analyze the related factors affecting the therapeutic effect of percutaneous transforaminal endoscopic discectomy (PTED) in patients with lumbar disc herniation (LDH) based on Logistic analysis.Methods 310 LDH patients from March 2019 to August 2022 were included in the study, all of them were treated with PTED. Clinical data of the patients were retrospectively collected. All patients were followed up for 1 year, of which 259 cases had excellent therapeutic effects and were included in the excellent group, and 51 cases with good or poor efficacy were included in the non-excellent group. The factors influencing the curative effect of PTED in patients with LDH were analyzed by univariate analysis and multivariate Logistic regression analysis.Results 310 cases of LDH were treated by PTED. During 1-year follow-up, 259 cases had excellent curative effect, and the rate of excellent was 83.55%. Compared with the excellent group, the proportions of age > 50 years, the pain presented as back and leg pain, the course of LDH > 1 year, lateral recess stenosis, annulus fibrosus rupture, Modic change, the working mode of weight-bearing or long-term fixed posture, the Pfirrmann grade of disc degeneration Ⅲ~Ⅳ were higher (P < 0.05). The multivariate Logistic regression analysis showed that age > 50 years old (OR＾ = 1.022, 95%CI: 1.006 ~ 1.038), pain manifested as lower back and leg pain (OR＾ = 1.059, 95%CI: 1.036~1.081), lateral recess stenosis (OR＾ = 1.069, 95%CI: 1.020 ~ 1.120), and working mode in a weight-bearing or long-term fixed position (OR＾ = 1.064, 95%CI: 1.025 ~ 1.104) were non excellent risk factors for PTED treatment efficacy in LDH patients (P < 0.05).Conclusion The curative effect rate of patients with LDH by PTED for 1-year follow-up is 83.55%, there are many factors that affect the efficacy, such as age > 50 years, pain manifested as lower back and leg pain, lateral recess stenosis, working mode in a weight-bearing or long-term fixed position. Corresponding intervention measures could be taken clinically based on this.