The Study Of Risk Factors Of Single-segment Lumbar Disc Herniation

Objective:To explore the main risk factors of the incidence of single-segment lumbar disc herniation（LDH）and the recurrence after microscopic nucleus resection,and provide scientific basis for the prevention and treatment of LDH.Methods:1.Using a case-control study,from March to December 2019,120 patients with L_4/5 or L₅/S₁ single-segment LDH who were admitted to the First Affiliated Hospital of Nanhua University were selected as the case group.Match the same gender,age,nationality and region 120 non-LDH community residents were selected as the control group.A total of120 pairs research objects.The research subjects were survey using by self-made questionnaires was made into Questionnaire star form.The content of the survey includes five aspects:general information,living and living conditions,work conditions,health status and LDH daily protection behavior score.Pairedχ2 test,paired t test and binary classification Conditional Logistic stepwise regression were used to analyze the main risk factors of single-segment LDH.2.From January 2016 to June 2018,52 patients with recurrence of single-segment LDH after transforaminal nucleus resection were selected as the relapse group,and sixty patients who with similar age and no recurrence after surgery were selected randomly as the control group.Combined with clinical data and using a self-designed questionnaire,face-to-face investigation of the general condition,illness,surgery and postoperative life and rehabilitation behaviors.To investigate the risk factors for recurrence after interforaminal endoscopic discectomy.Results:1.Single factor analysis of single-segment LDH showed that:BMI（χ²=7.384,P=0.007）,humidity of the living environment（χ²=6.000,P=0.020）,smoking（χ²=6.095,P=0.014）,Mattress softness（χ²=14.343,P=0.000）,type of labor（χ²=14.696,P=0.000）,working posture（χ²=15.680,P=0.000）,single posture maintenance time（χ²=26.889,P=0.000）,spinal load（χ²=8.450,P=0.004）,family history of LDH（χ²=10.240,P=0.001）,and LDH protective behavior score（t=2.266,P=0.024）are a total of 10 factors related to the incidence of LDH.Comparing between two groups,a total of 19 indicators include cultural degree,marital status,waist circumference,economic income,climb stairs,drinking habits,spicy food intake,decubitus,bed time,housework and exercise,occupation,weight method,repeated bending,filling calcium,waist injury history,surgical history,history of diabetes and hypertension all had no statistical significance（all P>0.05）,and show no correlation to the patients with LDH.2.Multivariate analysis of the incidence of single-segment LDH showed that:BMI≥25 kg/m2（OR=2.668,95%CI:1.309⁵.436）,humidity of the living environment（OR=2.242,95%CI:1.116⁴.505）,type of manual labor（OR=2.419,95%CI:1.086⁴.250）,class B working posture（OR=2.491,95%CI:1.276⁴.860）,single posture maintenance time>4 hours（OR=10.294,95%CI:4.834²1.919）,spinal load≥35Kg（OR=6.404,95%CI:2.062¹9.889）,and family history of LDH（OR=2.868,95%CI:1.071⁷.677）all were independent risk factors for LDH.and long-term sleeping soft mattress（OR=0.282,95%CI:0.146⁰.547）was the protective factor of LDH.3.908 patients with single-segment LDH underwent resection of the nucleus pulposus under the intervertebral foramen microscope,and 52 patients had postoperative recurrence,with a recurrence rate of 5.73%.4.The single-factor analysis results of postoperative recurrence showed that:the history of diabetes or hypertension,smoking,BMI,pathological classification,high-intensity activity,rehabilitation exercise,and work/study posture were correlated with postoperative recurrence of LDH（all P<0.05）.However,there were no statistically significant differences between the two groups in gender,age,course of disease,herniated segment,improved disc degeneration Pfirrmann grading,and postoperative JOA score comparison（all P>0.05）,there all indicating no correlation with postoperative recurrence of LDH.5.Multivariate analysis of postoperative recurrence showed:BMI≥28（OR=3.520,95%CI:1.120-11.063）,smoking（OR=4.216,95%CI:1.365-13.025）,history of diabetes or hypertension（OR=4.829,95%CI:1.123-20.764）,prominent pathological classification（OR=8.542,95%CI:2.662-27.411）,high-intensity postoperative activities（OR=24.033,95%CI:5.377-107.424）5indicators were independent risk factors for recurrence after LDH,and Correct working/learning posture（OR=0.026,95%CI:0.005-0.128）was the protective factor for recurrence after LDH.Conclusions:1.The effects of age and sex were excluded,BMI≥25 kg/m²,humidity of the living environment,soft mattress,type of physical labor,type B working posture,long-term maintenance of single position,large spinal load and family history of lumbar disc herniation were independent risk factors of lumbar disc herniation.2.Smoking,history of diabetes and hypertension,prominent pathological classification,high postoperative intensity of activity,and poor postoperatively working/learning posture were independent risk factors for recurrence after interforaminal nuclear pulpotomy.