基于磁共振成像参数和临床特征分析腰椎间盘突出症经皮椎间孔镜椎间盘切除术疗效的影响因素

The factors influencing the curative effect of percutaneous transforaminal endoscopic discectomy for lumbar disc herniation based on MRI indexes and clinical features

摘要:

目的 基于磁共振成像（MRI）参数和临床特征分析腰椎间盘突出症（LDH）经皮椎间孔镜椎间盘切除术（PTED）疗效的影响因素。方法 选取2019年12月－2022年5月浙江中医药大学附属温岭市中医院和浙江金华广福肿瘤医院收治的302例LDH患者为研究对象，均接受PTED治疗，具备1年随访资料。其中，疗效为优良的272例纳入预后良好组，疗效可的30例纳入预后不良组。回顾性收集研究对象一般资料、MRI参数和临床特征。通过单因素分析和多因素Logistic回归分析法，分析影响LDH患者PTED疗效的因素。结果 随访1年，302例LDH患者，优205例，良67例，30例疗效为可，0例疗效为差，预后不良率为9.93%。与预后良好组比较，预后不良组吸烟和椎间盘退变Ⅳ级比例更高，手术时间更长，腰大肌横截面面积（CSA）差值绝对值和多裂肌CSA差值绝对值更大，椎间孔面积更小，差异均有统计学意义（P < 0.05）；两组患者年龄、体重指数（BMI）、性别、饮酒、糖尿病、高血压、高血脂、纤维环破裂、病变段、Lee分区、Modic改变、术中出血量、切口长度、手术入路和关节镜型号比较，差异均无统计学意义（P > 0.05）；多因素Logistic分析结果显示：吸烟（OR＾ = 4.179，95%CI：1.035～16.865）、椎间盘退变Ⅳ级（OR＾ = 6.863，95%CI：2.049～22.983）、腰大肌CSA差值绝对值 > 1.63 cm²（OR＾ = 19.084，95%CI：3.566～102.130）和多裂肌CSA差值绝对值 > 1.02 cm²（OR＾ = 482.525，95%CI：19.538～12 137.347）为LDH患者PTED预后不良的危险因素，差异均有统计学意义（P < 0.05）；椎间孔面积 > 118.31 mm²（OR＾ = 0.750，95%CI：0.721～0.862）为LDH患者PTED预后不良的保护因素，差异有统计学意义（P < 0.05）。结论 吸烟、椎间盘退变Ⅳ级、腰大肌CSA差值 > 1.63 cm²和多裂肌CSA差值绝对值 > 1.02 cm²是LDH患者PTED预后不良的危险因素，椎间孔面积 > 118.31 mm²是LDH患者PTED预后不良的保护因素。临床可筛选预后不良的高危患者，并采取相应的干预对策。

Abstract:

Objective Based on magnetic resonance imaging (MRI) indexes and clinical characteristics to analyze the factors affecting the curative effect of percutaneous transforaminal endoscopic discectomy (PTED) in patients with lumbar disc herniation (LDH).Methods 302 patients with LDH from December 2019 to May 2022 were included in the study, all of whom received PTED with 1-year follow-up data. Among of them, 272 cases had excellent curative effect and were included in the good prognosis group, while 30 cases had reasonable curative effect and were included in the poor prognosis group. General data, MRI indexes and clinical features of the subjects were collected retrospectively. Univariate analysis and multivariate Logistic regression analysis were used to analyze the influencing factors of curative effect in patients with LDH after PTED.Results In 302 cases of LDH, the excellent in 205 cases, good in 67 cases, fair in 30 cases and poor in 0 case, the prognosis rate was 9.93%. Compared with the good prognosis group, the poor prognosis group had higher proportions of smoking, disc degeneration, longer operation time, higher absolute difference in cross-sectional area (CSA) of psoas major and multifidi, and lower intervertebral foramen area, with statistical significance (P < 0.05). There was no significant difference in age, body mass index (BMI), gender, alcohol consumption, diabetes mellitus, hypertension, hyperlipidemia, annulus fibrosus rupture, lesion segment, Lee zone, Modic change, intraoperative blood loss, incision length, surgical approach, and arthroscopic model between the two groups (P > 0.05). The multivariate Logistic analysis showed that: Smoking (OR＾ = 4.179, 95%CI: 1.035 ~ 16.865), grade IV disc degeneration (OR＾ = 6.863, 95%CI: 2.049 ~ 22.983), the difference of CSA of psoas major > 1.63 cm² (OR＾ = 19.084, 95%CI: 3.566 ~ 102.130) and the difference of CSA of multifidi > 1.02 cm² (OR＾ = 482.525, 95%CI: 19.538 ~ 12 137.347) were risk factors for poor prognosis of patients with LDH after PTED, the differences were statistically significant (P < 0.05). The intervertebral foramen area > 118.31 mm² (OR＾ = 0.750, 95%CI: 0.721 ~ 0.862) was protective factor for poor prognosis of patients with LDH after PTED, and the difference was statistically significant (P < 0.05).Conclusion Smoking, grade IV intervertebral disc degeneration, greater than 1.63 cm² absolute difference in psoas major CSA, and greater than 1.02 cm² absolute difference in multifidi CSA are risk factors for poor prognosis of PTED in LDH patients. Intervertebral foramen area > 118.31 mm² is a protective factor for poor prognosis of PTED in LDH patients. Clinically, high-risk patients with poor prognosis can be screened and corresponding intervention strategies can be taken.