Department of Orthopedic Surgery, Shaoxing People's Hospital, Shaoxing, Zhejiang Province, China.
Department of Orthopedics, Shanghai Changhai Hospital of Naval Medical University, Shanghai, China.
J Orthop Surg Res. 2022 Jul 16;17(1):356. doi: 10.1186/s13018-022-03242-x.
To evaluate the clinical features of and risk factors for recurrent lumbar disc herniation (rLDH) after percutaneous endoscopic lumbar discectomy (PELD) in our clinical practice.
A total of 942 consecutive patients who underwent single-level PELD from January 2013 to August 2019 were included. Patients were divided into the recurrence group and the nonrecurrence group. Patient characteristics, radiographic parameters and surgical variables were compared between the two groups. Univariate analysis and multiple logistic regression analysis were adopted to determine the risk factors for recurrence after PELD.
The prevalence of rLDH was 6.05%. Age, sex, tobacco use, duration of low back pain, body mass index (BMI), occupational lifting, herniated disc type, facet joint degeneration, operation time and time to ambulation were significantly different between the two groups. Univariate analysis showed that age (P < 0.001), sex (P = 0.019), BMI (P = 0.001), current smoking (P < 0.001), occupational lifting (P < 0.001), facet joint degeneration (P = 0.001), operation time (P = 0.002), and time to ambulation (P < 0.001) could be significantly associated with the incidence of rLDH after PELD. Multivariate analysis suggested that an older age (P < 0.001), the male sex (P = 0.017), a high BMI (P < 0.001), heavy work (P = 0.003), grade II facet joint degeneration (P < 0.001) and early ambulation (P < 0.001) were significantly related to rLDH after PELD.
An older age, the male sex, a higher BMI, heavy work, grade II facet joint degeneration, and early ambulation are independent significant risk factors for rLDH after PELD. Great importance should be attached to these risk factors to prevent rLDH. We suggest that patients control their weight, avoid heavy work, ambulate at an appropriate time, and perform strengthening rehabilitation exercises to reduce the incidence of rLDH.
评估经皮内镜腰椎间盘切除术（PELD）后复发性腰椎间盘突出症（rLDH）的临床特征和危险因素。
纳入 2013 年 1 月至 2019 年 8 月期间接受单节段 PELD 的 942 例连续患者。患者分为复发组和未复发组。比较两组患者的一般资料、影像学参数和手术变量。采用单因素分析和多因素逻辑回归分析确定 PELD 后复发的危险因素。
rLDH 的患病率为 6.05%。两组间年龄、性别、吸烟、腰痛持续时间、体重指数（BMI）、职业性体力劳动、椎间盘突出类型、小关节退变、手术时间和下床活动时间均有显著差异。单因素分析显示，年龄（P<0.001）、性别（P=0.019）、BMI（P=0.001）、吸烟（P<0.001）、职业性体力劳动（P<0.001）、小关节退变（P=0.001）、手术时间（P=0.002）和下床活动时间（P<0.001）与 PELD 后 rLDH 的发生率显著相关。多因素分析提示年龄较大（P<0.001）、男性（P=0.017）、BMI 较高（P<0.001）、重体力劳动（P=0.003）、II 级小关节退变（P<0.001）和早期下床活动（P<0.001）与 PELD 后 rLDH 显著相关。
年龄较大、男性、BMI 较高、重体力劳动、II 级小关节退变和早期下床活动是 PELD 后 rLDH 的独立显著危险因素。应高度重视这些危险因素以预防 rLDH。我们建议患者控制体重、避免重体力劳动、适当下床活动，并进行强化康复锻炼，以降低 rLDH 的发生率。
