腰椎全板减压术后顽固下腰痛的原因分析

Predictors of residual low back pain after laminectomy for degenerative lumbar stenosis

[目的]分析腰椎全板切除术后残留下腰痛的原因,指导选择合理的手术方法。[方法]回顾分析1996～2000年作者采用全椎板切除减压治疗的腰椎管狭窄症患者临床资料,69例获得5年以上随访的患者作为本组研究对象,使用日本骨科学会(JOA)标准对患者的神经功能和下腰痛程度进行评分,根据手术前后下腰痛程度的变化将病例分为无残存下腰痛(lowbackpain,LBP)组和残存LBP组,针对术前的临床和影像学参数,使用软件包SPSS13.0进行对数回归分析,确定术后残存下腰痛的临床预测因素,并对这些影响因素进行两组间比较和统计分析。[结果]术前腰椎前突角、腰椎活动度和手术减压范围与术后残存下腰痛密切相关。残存LBP组患者术前腰椎生理前突和活动度分别为(22.27°±3.12°)和(22.91°±2.31°),显著低于无残存LBP组患者的腰椎前突和活动度(37.23°±2.19°)和(31.66°±1.52°),P值分别为0.000和0.002;而残存LBP组的减压节段(2.77±0.19节)明显高于无残存LBP组(1.70±0.10节),P值为0.000。[结论]对于术前腰椎前突减小,腰椎活动度下降的椎管狭窄症患者单纯施行多节段的腰椎全板减压容易导致术后顽固性下腰痛的出现,应引起作者重视。

[ Objective] To detect the predictors of residual low back pain （LBP） after laminectomy. [ Method] From 1996 to 2000, 69 cases （31 males and 38 females） of degenerative lumbar stenosis who had underwent laminectomy treatment and with at least 5 years＇ follow-up documents were involved in this study. LBP were evaluated by the Japan Orthopedic Association （JOA） Scoring System （3 points） pre- and post operation. The relationship between the patients＇ outcomes and all these clinical and radiographic parameters were analyzed by software package SPSS 13.0. [ Result] Twenty-two cases wereclassified as residual LBP group （ group 1 ） and 47 cases as no-residual LBP group （ group 2）, binary logistic regression analysis indicated that the predictors of residual LBP were preoperative lumbar lordosis angle, ROM and the number of decompressed laminae. The forward comparison revealed that the lumbar lordosis （22. 27°±3.12°） and ROM （22.91°±2. 31°） in group 2 were lower than the lordosis angle （37. 23 °±2.19° ） and ROM （31.66°± 1.52° ） in group 1, but the number of decompressed lami- line of group 2 （2. 77°±0.19° ） were higher than that in group 1 （ 1.70 °±0. 10° ） significantly, the P values were 0. 000, 0. 002 and 0. 000 respectively. [ Conclusion ] Residual LBP may attribute to the decrease of compensation ability to the postoperative instable tendency on a more flat and inflexible lumbar spine especially for multi-laminectomy, so that more attention should be paid to these kind of patients to avoid the development of refractory residual LBP.