【摘要】：目的:1、分析內(nèi)窺鏡下腰椎髓核摘除術(shù)(MED)術(shù)后復(fù)發(fā)的危險因素。2、評價MED聯(lián)合一次性纖維環(huán)縫合術(shù)治療腰椎間盤突出癥的安全性、臨床療效以及能否有效降低術(shù)后的復(fù)發(fā)率。方法:回顧性分析我院2011年6月至2014年3月收治的213例接受MED治療的腰椎間盤突出癥患者,男118例,女95例,平均38.07±13.23歲。記錄年齡、體重指數(shù)、椎間盤退變程度、手術(shù)節(jié)段及突出類型等危險因素�；仡櫺苑治鑫以�2012年3月至2014年3月收治的符合納入和排除標(biāo)準(zhǔn)的290例接受MED治療的單節(jié)段腰椎間盤突出癥患者,男160例,女130例,平均38.13±12.08歲。其中172例單純行椎間盤鏡髓核摘除術(shù)作為對照組,118例聯(lián)合行纖維環(huán)縫合術(shù)作為縫合組。記錄兩組手術(shù)時間、出血量、術(shù)前及隨訪時視覺模擬量表(VAS)評分、Oswestry功能障礙指數(shù)(ODI)。利用影像學(xué)資料測量術(shù)前及隨訪時手術(shù)節(jié)段椎間隙高度的變化�？ǚ綑z驗分析MED術(shù)后復(fù)發(fā)與年齡、體重指數(shù)、突出節(jié)段及類型、椎間盤退變程度等因素關(guān)系。采用Logistic回歸對危險因素進行多因素分析。結(jié)果:隨訪時間平均28.35±5.08個月(24～32個月)。兩組平均手術(shù)時間和平均手術(shù)出血量比較無統(tǒng)計學(xué)差異(P0.05)。縫合組和對照組兩組組內(nèi)ODI評分、腰痛VAS評分、下肢痛VAS評分術(shù)前與術(shù)后3個月、末次隨訪比較差異均有統(tǒng)計學(xué)意義(P0.05),兩組組間同時間對比無統(tǒng)計學(xué)差異(P0.05)。對照組末次隨訪椎間隙高度(8.29±1.43mm)較術(shù)前(10.34±1.74mm)降低19.83%,縫合組末次隨訪椎間隙高度(8.94±1.35mm)較術(shù)前(10.46±1.55mm)降低14.53%,兩組組間差異無統(tǒng)計學(xué)差異(F=1.461,P=0.230)。對照組術(shù)后同節(jié)段復(fù)發(fā)14例,復(fù)發(fā)率為8.14%,再手術(shù)患者6例,再手術(shù)率3.49%�？p合組術(shù)后3例患者復(fù)發(fā),復(fù)發(fā)率為2.54%,再手術(shù)患者1例,再手術(shù)率為0.85%.兩組復(fù)發(fā)率比較有統(tǒng)計學(xué)差異(χ2=3.973,P=0.046),再手術(shù)率有統(tǒng)計學(xué)差異。單因素及多因素多因素Logistic回歸分析顯示椎間盤退變程度、突出類型、術(shù)后活動程度與術(shù)后再次突出復(fù)發(fā)具有統(tǒng)計學(xué)差異。結(jié)論:1、內(nèi)窺鏡下髓核摘除術(shù)聯(lián)合纖維環(huán)縫合術(shù)治療LDH操作簡便、安全可行,同單純髓核摘除術(shù),均可獲得滿意的臨床療效。在嚴(yán)格適應(yīng)癥下,可有效降低腰椎髓核摘除術(shù)后的復(fù)發(fā)率及再手術(shù)率。2、椎間盤退變程度、突出類型及術(shù)后活動度為MED術(shù)后再次突出復(fù)發(fā)的危險因素。
[Abstract]:Objective to analyze the risk factors of recurrence of lumbar spinal nucleus pulposus resection (MED) under endoscope, and to evaluate the safety, clinical effect and effective reduction of recurrence rate of lumbar intervertebral disc herniation treated by MED combined with one-off annular suture. Methods: two hundred and thirteen patients with lumbar disc herniation treated with MED from June 2011 to March 2014 were analyzed retrospectively. There were 118 males and 95 females with an average age of 38.07 鹵13.23 years. Age, BMI, degree of disc degeneration, surgical segment and type of herniation were recorded. From March 2012 to March 2014, 290 patients with single segment lumbar disc herniation (male 160, female 130, mean 38.13 鹵12.08 years old) who met the criteria of inclusion and exclusion were analyzed retrospectively. 172 cases were treated as control group, 118 cases were treated with annular suture. The time of operation, blood loss, visual analogue scale (VAS) score before operation and follow-up were recorded. Oswestry dysfunction index (ODI).) was recorded in both groups. Imaging data were used to measure the height of intervertebral space before operation and during follow-up. Chi square test was used to analyze the relationship between recurrence and age, body mass index, herniation segment and type, disc degeneration and so on. The risk factors were analyzed by Logistic regression. Results: the mean follow-up time was 28.35 鹵5.08 months (24 ~ 32 months). There was no significant difference between the two groups in the mean operative time and the mean amount of operative bleeding (P0.05). The ODI score, VAS score and lower extremity pain VAS score in the suture group and the control group were significantly higher than those in the control group before and 3 months after operation (P0.05), but there was no significant difference between the two groups in the same time (P0.05). The intervertebral space height of the control group (8.29 鹵1.43mm) was 19.83% lower than that of the preoperative (10.34 鹵1.74mm), and the intervertebral space height (8.94 鹵1.35mm) of the last follow-up group was 14.53% lower than that of the pre-operation group (10.46 鹵1.55mm). There was no significant difference between the two groups (F _ (1.461) P ~ (0.230). In the control group, there were 14 cases of recurrence in the same segment, the recurrence rate was 8.14%, and the reoperation rate was 3.49% in 6 cases of reoperation. In the suture group, the recurrence rate was 2.54, and the reoperation rate was 0.85. There was significant difference in recurrence rate between the two groups (蠂 2 / 3.973 P 0.046), and there was a statistical difference in the rate of reoperation. Univariate and multivariate Logistic regression analysis showed that the degree of disc degeneration, the type of herniation, the degree of postoperative activity and the recurrence of recurrent disc herniation were significantly different. Conclusion it is simple, safe and feasible to treat LDH with endoscopic excision of nucleus pulposus combined with annular suture, and satisfactory clinical effect can be obtained with the same simple extirpation of nucleus pulposus. Under strict indications, the recurrence rate and reoperation rate of lumbar nucleus pulposus can be reduced effectively. The degree of disc degeneration, the type of herniation and the postoperative activity are the risk factors of recurrence of recurrent herniation after MED.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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