腰椎手术失败综合征的危险因素分析

Analysis of the impact factors of failed back surgery syndrome

目的探讨腰椎手术失败综合征（FBSS）自身和外界危险因素,为临床治疗提供依据。方法选择2009年1月~2011年6月我院收治的行腰椎手术患者102例,其中FBSS患者28例,将其作为观察组,非FBSS 74例作为对照组,比较两组一般情况与可能的自身和外界危险因素。结果自身因素中,观察组与对照组年龄比较,差异有统计学意义（t=3.691,P〈0.05）。性别比例（χ2=1.908,P〉0.05）与手术时间（t=0.021,P〉0.05）比较,差异无统计学意义。观察组合并侧隐窝狭窄的患者与对照组比较,两组合并率差异有统计学意义（χ2=36.302,P〈0.05）。两组BMI≥25患者人数差异无统计学意义（χ2=2.820,P〉0.05）。手术相关因素中,观察组的手术指征不当（χ2=15.367）、手术方式不当（χ2=7.435）、减压范围不当（χ2=24.624）、手术定位不当（χ2=7.538）、椎间盘切除不彻底（χ2=7.644）和神经根减压不彻底（χ2=13.200）的发生率与对照组比较,差异均有统计学意义（均P〈0.05）。两组术后因素,如硬膜外疤痕粘连率（χ2=14.442）、椎间盘突出复发率（χ2=31.543）与椎间盘炎症的发生率（χ2=24.468）比较,差异均有统计学意义（均P〈0.05）。通过逐步回归分析发现,年龄、合并侧隐窝狭窄及并发症发生率与FBSS为正相关,手术指征不当、手术方式不当、减压范围不当、手术定位不当、椎间盘切除不彻底、神经根减压不彻底的发生率、硬膜外疤痕粘连率、椎间盘突出复发率与椎间盘炎症的发生率也与FBSS发生率成正相关。结论掌握影响FBSS发生的相关因素并针对其采取相应的预防措施,才能降低腰椎手术后FBSS的发生率,提高术后患者的生活质量。

Objective To analysis the impact factors of failed back surgery syndrome,in order to provide basis for clinical treatment.Methods A retrospective analysis of 102 patients who carred lumbar operation in our hospital from January 2009 to June 2011 and 28 patients with failed back surgery syndrome.All patients were divided into 2 groups.The patients with FBSS were the study group and the patients with non-FBSS were the control group.To compared the general status and impact factors of the 2 groups.Results The age of two groups were statistical different significantly（t = 3.691,P 0.05）.The ratio of genders（χ2 = 1.908,P 0.05）,time of operation（t = 0.021,P 0.05） and BMI≥25（χ2 = 2.820,P 0.05） for two groups were no statistical different significantly.The incidences of lateral recess（χ2 = 36.302,P 0.05）of two groups were statistical different significantly（t = 3.691,P 0.05）.The incidences of the inappropriate operational indications（χ2 = 15.367）,the inappropriate operational methods（χ2 = 7.435）,the inappropriate range for pressure（χ2 = 24.624）,inaccurate localization for surgery（χ2 = 7.538）,discs were removed incompletely（χ2 = 7.644）,incomplete anterior cervical decompression（χ2 = 13.200）,extradural scar adhesoions（χ2 = 14.442）,the recurrence of herniated disk（χ2 = 31.543） and postoperative discitis（χ2 = 24.468） were statistical different significantly.The relative factors of FBSS were age,the incidences of lateral recess,inappropriate operational indications,the inappropriate operational methods,the inappropriate range for pressure,inaccurate localization for surgery,discs were removed incompletely,incomplete anterior cervical decompression,extradural scar adhesoions,the recurrence of herniated disk and postoperative discitis.Conclusion To be drawn out corresponding to the influence factors for FBSS.It can improve the successful rate and audition increased,raise patient life quality.