腰椎间盘突出症手术治疗后的长期再手术率：一项全国性样本队列研究，随访 10 年。
The Long-term Reoperation Rate Following Surgery for Lumbar Herniated Intervertebral Disc Disease: A Nationwide Sample Cohort Study With a 10-year Follow-up.
机构信息
Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea.
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea.
出版信息
Spine (Phila Pa 1976). 2019 Oct 1;44(19):1382-1389. doi: 10.1097/BRS.0000000000003065.
STUDY DESIGN
A retrospective cohort study of a nationwide sample database.
OBJECTIVE
The objective of the present study was to compare the long-term incidence of reoperation for lumbar herniated intervertebral disc disease (HIVD) after major surgical techniques (open discectomy, OD; laminectomy; percutaneous endoscopic lumbar discectomy, PELD; fusion).
SUMMARY OF BACKGROUND DATA
HIVD is a major spinal affliction; if the disease is intractable, surgery is recommended. Considering both the aging of patients and the chronicity of lumbar degenerative disease, the effect of surgical treatment for the lumbar spine should be durable for as long as possible.
METHODS
The National Health Insurance Service-National Sample Cohort (NHIS-NSC) of Republic of Korea was utilized to establish a cohort of adult patients (N = 1856) who underwent first surgery for lumbar HIVD during 2005 to 2007. Patients were followed for 8 to 10 years. Considering death before reoperation as a competing event, reoperation hazards were compared among surgical techniques using the Fine and Gray regression model after adjustment for age, gender, Charlson comorbidity score, osteoporosis, diabetes, the severity of disability, insurance type, and hospital type.
RESULTS
The overall cumulative incidences of reoperation were 4% at 1 year, 6% at 2 years, 8% at 3 years, 11% at 5 years, and 16% at 10 years. The cumulative incidences of reoperation were 16%, 14%, 16%, and 10% after OD, laminectomy, PELD, and fusion, respectively, at 10 years postoperation, with no difference among the surgical techniques. However, the distribution of reoperation types was significantly different according to the first surgical technique (P < 0.01). OD was selected as the reoperation surgical technique in 80% of patients after OD and in 81% of patients after PELD.
CONCLUSION
The probability of reoperation did not differ among OD, laminectomy, PELD, and fusion during the 10-year follow-up period. However, OD was the most commonly used technique in reoperation.
LEVEL OF EVIDENCE
研究设计
一项全国性样本数据库的回顾性队列研究。
目的
本研究的目的是比较主要手术（开放椎间盘切除术、OD；椎板切除术；经皮内镜腰椎间盘切除术、PELD；融合）治疗腰椎间盘突出症（HIVD）后长期再手术的发生率。
背景资料概要
HIVD 是一种主要的脊柱疾病；如果疾病难以治疗，建议进行手术。考虑到患者的老龄化和腰椎退行性疾病的慢性，脊柱手术的效果应尽可能持久。
方法
利用韩国国民健康保险服务-国家样本队列（NHIS-NSC）建立了一个在 2005 年至 2007 年间接受首次腰椎 HIVD 手术的成年患者队列（N=1856）。患者随访 8 至 10 年。考虑到再手术前死亡为竞争事件，使用 Fine 和 Gray 回归模型对手术技术进行调整后，比较了年龄、性别、Charlson 合并症评分、骨质疏松症、糖尿病、残疾严重程度、保险类型和医院类型后，手术技术之间的再手术风险。
结果
总体再手术累积发生率为第 1 年 4%、第 2 年 6%、第 3 年 8%、第 5 年 11%和第 10 年 16%。OD、椎板切除术、PELD 和融合术后 10 年的再手术累积发生率分别为 16%、14%、16%和 10%，手术技术之间无差异。然而，根据首次手术技术，再手术类型的分布差异显著（P<0.01）。OD 后 80%的患者和 PELD 后 81%的患者选择 OD 作为再手术手术技术。
结论
在 10 年随访期间，OD、椎板切除术、PELD 和融合之间的再手术概率无差异。然而，OD 是再手术中最常用的技术。
证据水平
4 级。
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