| 张宏鑫,李明涛,石小龙,等.经椎间孔硬膜外类固醇注射治疗脊柱内镜减压术后复发性腰椎间盘突出症的有效性和预后预测因素.骨科,2026,17(3): 219-224. |
| 经椎间孔硬膜外类固醇注射治疗脊柱内镜减压术后复发性腰椎间盘突出症的有效性和预后预测因素 |
| Effectiveness and prognostic factors of transforaminal epidural steroid injection for recurrent lumbar disc herniation after endoscopic spinal decompression surgery |
| 投稿时间：2025-06-06 |
| DOI：10.3969/j.issn.1674-8573.2026.03.004 |
| 中文关键词: 复发性腰椎间盘突出症 经椎间孔硬膜外类固醇注射 预后 腰痛 预测因素 |
| 英文关键词: Recurrent lumbar disc herniation Transforaminal epidural steroid injection Prognosis Low back pain Prognostic factors |
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| 中文摘要: |
| 目的 评估经椎间孔硬膜外类固醇注射（ESI）治疗脊柱内镜减压术后复发性腰椎间盘突出症（rLDH）的有效性和预后预测因素，为临床提供精准的个体化治疗决策依据。方法 回顾性分析2021年1月至2023年10月接受经椎间孔ESI治疗的90例rLDH患者。记录患者的基本信息、临床症状、影像学指标及随访结果。通过单因素分析和多因素Logistic回归分析确定影响治疗预后的关键因素。结果 90例患者共接受149次ESI治疗，疼痛视觉模拟量表（VAS）评分从术前的（6.61±1.82）分降至术后的（2.96±1.73）分，差异有统计学意义（P＜0.05）。随访期间，35例患者（38.89%）因症状缓解不显著再次接受手术治疗。回归分析结果显示，疼痛伴感觉/运动障碍[OR=5.499，95% CI（1.913，15.808），P=0.002]、椎间盘突出比例≥2.0[OR=6.573，95% CI（1.687，25.605），P=0.007]和注射3次[OR=8.418，95% CI（1.390，50.987），P=0.020]是rLDH患者经椎间孔ESI治疗后再次手术的独立危险因素；通过1 000次Bootstrap重抽样进行该回归模型的内部验证，结果得出该回归模型的整体稳健性较好，但“注射次数”的系数波动较大。结论 经椎间孔ESI治疗rLDH可有效减轻根性疼痛，使多数患者从中受益；但疼痛伴感觉/运动障碍、椎间盘突出比例≥2.0和注射3次的患者，再次手术风险较高。 |
| 英文摘要: |
| Objective To evaluate the effectiveness and prognostic predictors of transforaminal epidural steroid injection (ESI) in treating recurrent lumbar disc herniation (rLDH) after spinal endoscopic decompression surgery, aiming to provide precise individualized clinical decision-making guidance. Methods A retrospective analysis was conducted on 90 rLDH patients treated with transforaminal ESI between January 2021 and October 2023. Demographic data, clinical symptoms, imaging findings, and follow-up outcomes were recorded. Key prognostic factors were identified through univariate and multivariate Logistic regression analyses. Results A total of 90 patients (149 injections) were administered. The visual analogue scale (VAS) score for pain decreased significantly from preoperative 6.61±1.82 to postoperative 2.96±1.73 (P＜0.05). During follow-up, 35 patients (38.89%) required reoperation due to inadequate symptom relief. Univariate and multivariate analyses revealed that pain accompanied by sensory/motor deficits [OR=5.499, 95% CI(1.913, 15.808), P=0.002], disc herniation ratio ≥2.0 [OR=6.573, 95% CI(1.687, 25.605), P=0.007], and receiving 3 injections [OR=8.418, 95% CI(1.390, 50.987), P=0.020] were independent risk factors for reoperation. The internal validation of this regression model was conducted through 1, 000 Bootstrap resampling iterations, and the results indicated that the overall robustness of the model was good, but the coefficient for “number of ESI injections” exhibited relatively large fluctuations. Conclusion Transforaminal ESI effectively alleviates radicular pain in most rLDH patients. However, those with pain combined with sensory/motor deficits, disc herniation ratio ≥2.0, or requiring 3 sessions face higher risks of reoperation. |
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