摘要
目的探讨腰椎间盘突出患者行髓核摘除与腰椎融合内固定术后复发的影响因素及其预防策略。方法对我院骨科2010年1月～2013年12月间收治的腰椎间盘突出症住院接受髓核摘除与腰椎融合内固定手术的68例病人进行前瞻性随访观察,对其复发情况及临床随访资料进行分析,采用多因素Logistic回归分析探讨腰椎间盘突出患者行髓核摘除与腰椎融合内固定术后复发的影响因素。结果腰椎间盘突出患者行髓核摘除与腰椎融合内固定术后复发主要原因为髓核突出、椎间盘中重度退变、侧隐窝狭窄、瘢痕组织粘连、腰椎继发性不稳、继发神经根通道狭窄。糖尿病高血压史、疾病类型、病理分型、手术切除方式、是否有手术节段残留、术后有无康复锻炼、术后有无高强度劳动是术后复发的影响因素。有糖尿病、高血压病史的患者术后复发的可能性是没有者的2.742倍（P〈0.05）。复杂型腰椎间盘突出患者是单纯性突出患者出现复发的可能性的3.360倍（P〈0.05）。脱出、游离型患者术后复发的概率大于突出型。采用全椎体切除的患者复发较开窗切除者概率也更容易复发;手术椎体摘除不完全者是椎体完全摘除者的3.284倍（P〈0.05）;因锻炼发生复发的可能性是未锻炼者3.377倍（P〈0.05）,术后进行高强度劳动者更容易复发。结论糖尿病高血压史、疾病类型、病理分型、手术切除方式、是否有手术节段残留、术后有无康复训炼、术后有无高强度劳动是腰椎间盘突出患者行髓核摘除与腰椎融合内固定术后复发率相关。正确借助术前检查等手段评估患者病情、选取适当的治疗手段可有效降低腰椎间盘突出症的复发率。
Objective To know the main reasons of recurrence after the operation of lumbar nucleus pulposus re- moval and lumbar fusion with internal fixation to patients with lumbar intervertebral disc protrusion and discuss the influ- ence factors of postoperative relapse and its prevention strategies. Methods 68 patielats with lumbar intervertebral disc protrusion for surgery of lumbar nucleus Pulposus removal and lumbar fusion with internal fixation were involved in the present study. The influence factors of postoperative recurrence were analyzed by the multi-factor Logistic regression model. Results The postoperative recurrence of lumbar nucleus pulposus removal and lumbar fusion with internal fixa- tion can be attributed to six main reasons： herniated intervertebral disc moderately severe degeneration, lateral recess ste- nosis, scar tissue adhesion, lumbar secondary instability and secondary nerve root channel narrow. Additionally, the fac- tors of history of diabetes or hypertension, the type of disease, the pathological classification, the way of surgical remov- al, Residue of pulposus section, postoperative rehabilitation exercise and high intensity of labor may bring about postop- erative relapse. The possibility of relapse of patients with a history of diabetes or hypertension was 2. 742 times as the ones without hypertension （P〈0.05）. Compare with the suppleness, patients with complicated lumbar intervertebral disc protrusion highlight the possibility of recurrence with 3. 360 times （P〈0.05）. The relapse probability of patients with lumbar nucleus pulposus prolapse is greater than the extrude （P〈0.05）. Patients with posterior vertebral column resection more likely to recurrence than the antrostomy （P〈0.05）. The recurrence rate of patients with incomplete Surgical removal of destructed vertebral bodies is 3. 284 times as the complete removal （P〈0. 05） ; The patients without postoperative exercise and high strength workers are more likely to relapse （P〈0. 05）. Conclusion The
出处
《西部医学》
2015年第8期1144-1147,共4页
Medical Journal of West China
基金
军队临床高新技术重点项目(10ZYZ101)
关键词
腰椎间盘突出
复发
影响因素
Lumbar disc herniation
Relapser Affecting factors
