体质指数与腰椎间盘突出症术后疗效的关系

Correlation between surgical outcomes and body mass index in patients with lumbar disc herniation

目的探讨体质指数(bodymassindex,BMI)与腰椎间盘突出症手术疗效的关系。方法研究对象为住院行腰椎间盘突出症手术治疗的患者,共448例。术前记录患者身高、体重,并计算BMI(体重/身高2,kg/m2)。根据BMI将患者分为三组:正常组BMI<24,超重组BMI为24～28,肥胖组BMI>28。根据北美脊柱协会制定的60项指标结合临床实际制定出疗效评价量表,调查术后症状、体征、术后生活能力及术后恢复工作情况。结果全部病例均获随访,随访时间2.08～5.16年,平均2.48年。正常组较肥胖组的术后改善率好,差异有显著性(P<0.01或P<0.05);三组间术后腰部疼痛程度和下肢麻木程度比较差异无显著性(P>0.05);术后恢复工作能力方面正常组较肥胖组好(P<0.05);生活能力方面三组间差异无显著性(P>0.05);男女患者在改善率、术后腰部疼痛和术后下肢麻木程度上差异有显著性(P<0.05或P<0.01)。结论BMI过高,即肥胖是腰椎间盘手术的不利因素,特别对于女性患者,减轻体重可能是术后康复的重要内容之一。

Objective To investigate the correlation between surgical outcomes and body mass index (BMI) in patients with lumbar disc herniation. Methods 448 patients who underwent operative treatment for lumbar disc herniation were followed-up consecutively. The height and body weight of each patient was measured and recorded preoperatively. The BMI was calculated by the following formula, BMI=weight/height2 (kg/m2). The patients were asigned into three groups (normal group, BMI < 24; over-weight group, 24 ≤ BMI ≤28; and obese group, BMI > 28) based on the BMI. A questionnaire evaluation form was designed according to the 60 indexes put forward by North American Spine Association and the authors' clinical experiences. The post-operative signs and symptoms, living and working ability of the patients were evaluated by the questionnaire. Results Among the total 448 patients, none was lost for follow-up and all the patients were followed-up for average 2.48 (2.08-5.16) years. The improvement rate of the normal group was significantly higher than that of the obese group(P< 0.01 or P< 0.05). In terms of low-back pain and numbness of lower limbs after surgery, no significant statistic difference was detected in the three groups (P > 0.05). The post-operative working ability of the patients in the normal group recovered more quickly than that of the patients in obese group (P< 0.05). But there was no difference in life ability among the three groups (P > 0.05). The remission rate, the post-operative pain and numbness between the male and the female were significantly different(P< 0.05 or P< 0.01). Conclusion Higher BMI or obesity exert negative influence on the results of operative treatment for lumbar disc herniation. Body weight control, especially for female patients, may consist one of the most important contents of postoperative rehabilitation.