快速牵引联合骶裂孔注射治疗腰椎间盘突出症疗效的影响因素研究

Influencing factors on the traction plus epidural block for lumbar disc herniation

目的探讨影响快速牵引联合骶裂孔注射治疗腰椎间盘突出症疗效的相关因素,为提高腰椎间盘突出症的治疗效果提供依据。方法收集2005年1月至2009年1月在山东大学齐鲁医院康复医学科进行快速牵引联合骶裂孔注射治疗的270例腰椎间盘突出症患者的资料。统计患者性别、年龄、诱因、职业性质、病程、既往病史、临床症状(JOA得分)、突出类型、突出节段、突出数量、突出大小、椎管或侧隐窝有无狭窄作为自变量,患者疗效作为因变量。对其进行单因素分析,并对单因素分析有差异的进行多因素Logistic回归分析。结果单因素分析结果表明,病程、椎管及侧隐窝有无狭窄、发病诱因、临床症状(JOA评分)、突出类型、突出位置与腰椎间盘突出症预后差异有统计学意义(P<0.05)。进一步多因素Logistic回归分析表明病程、椎管及侧隐窝有无狭窄、发病诱因是影响疗效的独立危险因素。结论病程越长、椎管或/和侧隐窝狭窄、无发病诱因是影响快速牵引联合骶裂孔注射治疗腰椎间盘突出症疗效的独立危险因素,应对其进行相关干预,以提高治疗效果。

Objective To explore related factors with the effect of epidural block plus SLR exercise for lumbar disc herni-ation,and further improve the efficacy of treatment.Methods The data of 270 lumbar disc herniation cases,treated with epidural block plus SLR exercise from January 2005 to January 2009 at the Department of Rehabilitation Qilu Hospital of Shandong University,were reviewed.Gender,age,incentives,occupation,duration,past medical history,clinical symp-toms （JOA score） ,protruding type,protruding segment,protruding size,and spinal canal or lateral recess stenosis were observed.Which treatment efficacy was the dependent variable,while the 12 other factors were the variables.Single factor analysis was performed,and multivariate logistic regression analysis was be done on the significant factors singled out.Re-sults Univariate analysis showed that duration,place of stenosis （spinal canal or lateral recess） ,with or without predis-posing factors,clinical symptoms （JOA score） ,protruding type,and protruding segment were significantly related to the prognosis of lumbar disc herniation（P0.05） .Multivariate logistic regression analysis further revealed that duration, place of stenosis,and predisposing factors were independent risk factors affecting the efficacy.Conclusion Long dura-tion,spinal canal and/or lateral recess stenosis,and no predisposing factors are independent risk factors which can affect the results of epidural block plus SLR exercise for lumbar disc herniation.These factors should be considered during the treatment.