Qian Hu, Wang Xiuqian, Zhang Zhuo, Yin Xianxiong, Ao Jun, Qin Jianpu
Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
Eur Spine J. 2025 Mar 29. doi: 10.1007/s00586-025-08808-x.
The effect of Type 2 diabetes mellitus (T2DM) on lumbar disc herniation (LDH) remains controversial. This retrospective cohort study aims to investigate the effect of T2DM on the LDH patients underwent percutaneous endoscopic lumbar discectomy (PELD) throughout pre, peri and post operation.
This study included patients underwent PELD surgery from October 2021 to January 2024. General data including age, gender and body mass index (BMI), hemoglobin, hypertension and coronary heart disease (CHD) were collected. Clinical data including Visual Analogue Scale (VAS) score, surgical time, blood loss, length of hospital stay, recurrence ratio and reoperation ratio were recorded. Imaging data include L1-5 cobb angle, lumbar range of motion (ROM), relative cross-sectional area (CSA) and fat infiltration ratio (FIR) of the paraspinal muscles, abdominal aorta calcification (AAC), disc Pfirrmann grading, herniated disc Michigan State University (MSU) classification and Lee Zoning et al. were measured. Propensity score-matched (PSM) analysis with 1:1 ratio was performed to eliminate the influence of confounding factors using a multi-variable logistic regression model before analysis.
728 patients were eligible in this study, and significant difference was detected in age, hypertension and CHD between the T2DM group and Control group. After PSM analysis and matching, 56 pairs of patients generated and were included for further analysis. The patients in the T2DM possessed significantly higher grades of Pfirrmann score and AAC ratio (48.21% vs. 25.00%) than control group. Postoperative VAS of the T2DM group was 2(IQR = 1), which was significantly higher than the Control group, which was 1(IQR = 2). The recurrence and reoperation ratio were 21.43% and 16.07% respectively in the T2DM group, both of which were notably higher than the Control group (5.36% and 1.79%).
T2DM may aggravate disc degeneration, impede postoperative symptom relief, and increase recurrence and reoperation rates after PELD.
2型糖尿病（T2DM）对腰椎间盘突出症（LDH）的影响仍存在争议。本回顾性队列研究旨在调查T2DM对接受经皮内镜下腰椎间盘切除术（PELD）的LDH患者在术前、术中和术后的影响。
本研究纳入了2021年10月至2024年1月接受PELD手术的患者。收集患者的一般资料，包括年龄、性别、体重指数（BMI）、血红蛋白、高血压和冠心病（CHD）。记录临床资料，包括视觉模拟评分（VAS）、手术时间、失血量、住院时间、复发率和再次手术率。测量影像学资料，包括L1-5 Cobb角、腰椎活动度（ROM）、椎旁肌相对横截面积（CSA）和脂肪浸润率（FIR）、腹主动脉钙化（AAC）、椎间盘Pfirrmann分级、突出椎间盘密歇根州立大学（MSU）分类和李氏分区等。在分析前，采用多变量逻辑回归模型进行1:1倾向评分匹配（PSM）分析，以消除混杂因素的影响。
本研究共纳入728例患者，T2DM组和对照组在年龄、高血压和CHD方面存在显著差异。经过PSM分析和匹配后，产生了56对患者并纳入进一步分析。T2DM组患者的Pfirrmann评分和AAC比率显著高于对照组（48.21%对25.00%）。T2DM组术后VAS评分为2（四分位间距=1），显著高于对照组的1（四分位间距=2）。T2DM组的复发率和再次手术率分别为21.43%和16.07%，均显著高于对照组（5.36%和1.79%）。
T2DM可能会加重椎间盘退变，阻碍术后症状缓解，并增加PELD术后的复发率和再次手术率。
