退变性腰椎管狭窄减压术后下肢疼痛的恢复规律及影响因素

Regularity of melosalgia alleviation and analysis of relevant factors of surgical decompression for degenerative lumbar spinal stenosis

目的观察退变性腰椎管狭窄（degenerative lumbar spinal stenosis,DLSS）减压术后下肢疼痛的恢复规律,并探索影响疼痛恢复的相关因素。方法回顾性分析2013年1月至2014年12月于我科行腰椎管减压术治疗DLSS的153例患者。记录不同时间（术前、术后第1~7天、术后第1~12个月）患者的下肢疼痛视觉模拟量表（visual analogue scale,VAS）评分,观察其变化规律。选择年龄、性别、术前腰椎稳定性、术前VAS评分、手术节段、减压术式作为可能的影响因素,以有序Logistic回归分析影响术后下肢疼痛缓解的相关因素。结果下肢疼痛在减压术后即开始缓解,虽然在术后第2天出现疼痛反跳,但通过脱水及营养神经治疗,VAS评分在术后第5天恢复到术后第1天水平。术后3个月后疼痛缓解达到最佳,之后不再有明显变化。年龄、性别、术前VAS评分是影响椎管减压术后下肢疼痛改善的相关因素,而病程、手术节段、减压术式及术前腰椎稳定性与下肢疼痛改善无关。结论手术减压治疗DLSS术后下肢疼痛的恢复遵循一定规律,年轻、男性及术前疼痛程度较轻的患者实施腰椎管减压术后,其下肢疼痛恢复更好。

Objective To observe the regularity of melosalgia alleviation after surgical decompressionfor degenerative lumbar spinal stenosis（DLSS）, and find out the relevant factors. Methods Cases of DLSStreated in our hospital from January 2013 to December 2014 were abstracted on inclusive criteria and were sub-jected to surgical decompression. VAS scores for pain were recorded at different time points（pre-operation, thefirst 7 days post-operation, and the first day of each month in one year post-operation）, and change in VAS scorewas observed. Age, gender, pre-operative stability of lumbar spine, pre-operative VAS score, segments involved,and surgical procedures were selected for possible relevant factors. Ordinal Logistic regression analysis was per-formed to determine relevant factors. Results Melosalgia was released after surgery and best recovery ob-tained at the 3rd month, and thereafter lower limb pain seldom changed. Alleviation of pain re-bounced at the2 nd day. However, VAS score recovered to the same as the 1st day after surgery by dehydration and nerve nutri-tion treatment. Age, gender and pre-operative VAS score affected alleviation of melosalgia, whilst segments in-volved, method of surgical decompression, pre-operative stability of lumbar spine and time length of diseasewere irrelevant. Conclusion The melosalgia caused by DLSS was alleviated regularly after surgical decom-pression for DLSS. Younger male patients with less pre-operation lower limb pain obtained better alleviation af-ter surgical decompression.