腰椎管狭窄行腰椎减压术后腰痛改善的预测因素

摘要

目的 探讨腰椎管狭窄患者行未融合腰椎减压术术后早期(2周)下腰痛(low back pain, LBP)的改善情况,并进一步探讨腰椎减压术后腰痛改善的术前预测因素.方法 2006年1月-2016年12月,选取诊断为腰椎管狭窄(lumbar spinal stenosis, LSS)126例行单纯椎板切除或椎板开窗术,术前及术后2周、3个月、6个月采用疼痛视觉模拟评分(visual analogue scale, VAS)评估LBP的严重程度,采用单因素Logistic回归分析术后6个月残存LBP的危险因素,进一步采用多因素分析对年龄、性别和术前LBP进行校正.结果 术前及术后2周、3个月、6个月平均VAS评分分别为(4.3±3.2)、(1.3± 1.6)、(1.4±1.9)及(2.1±2.4),术后2周LBP显著改善(P＜0.001),2周～3个月相对较稳定,3～6个月显著加剧(P＜0.001).术后6个月LBP 患者VAS评分＞1比例降为60 (47.6%),对其残存LBP采用Logistic回归分析进行预测,得出术前LBP高VAS评分(P＜0.001),手术方式(P=0.04)、减压节段(P=0.007)、退行性脊柱侧凸(P=0.006)及Cobb角(P=0.002).多因素分析,在校正年龄、性别、术前VAS评分后,退行性脊柱侧凸(P=0.008)及Cobb角过大(P=0.003)是残存LBP的独立风险因素.结论 LSS患者行腰椎减压术后2周LBP显著改善.退行性脊柱侧凸和术前压迫严重对于腰椎减压术后是否发生残存LBP是有价值的预测因素.%Objective To investigate the improvement in LBP at early stage (2 weeks) after lumbar decompression surgery without fusion for lumbar spinal stenosis, and identify the preoperative predictors of LBP improvement after lumbar decompression surgery. Methods One handred and twenty six patients with symptoms of LSS treated by lumbar decompression surgery were enrolled into the study between January 2006 and December 2016.VAS scores were measured before surgery and 2 weeks, 3 months, and 6 months after surgery. Univariate logistic regression analyses were performed to identify the risk factors for residual LBP 6 months after surgery. Multivariate analysis was also performed after adjusting for age, gender, and preoperative LBP. Results The VAS scores for LBP before surgery and 2 weeks, 3 months, and 6 months after surgery were 4.3±3.2, 1.3±1.6, 1.4±1.9 and 2.1±2.4, respectively. LBP significantly improved 2 weeks after surgery (P＜ 0.001), stabilized between 2 weeks and 3 months after surgery, but was significantly aggravated 36 months after surgery (P＜ 0.001). At 6 months after surgery, 60 (47.6%) patients had a VAS score of ＞1. 60 patients with a VAS score of ＞1 at 6 months after surgery by using logistic regression analysis. The predictors of residual LBP included severe preoperative LBP (P＜0.001), surgical techniques(P=0.04), levels of decompression (P=0.007), degenerative scoliosis (P=0.006) and the size of the Cobb angle (P=0.002). The independent predictors, determined by multivariate analysis were degenerative scoliosis (P=0.008) and the size of the Cobb angle (P=0.003). Conclusion LBP is alleviated at 2 weeks after lumbar decompression surgery for lumbar spinal stenosis. The predictors of residual LBP after decompression include degenerative scoliosis and the size of Cobb angle.