手术治疗腰椎退行性疾患所致足下垂的预后影响因素分析

The analysis of prognostic factors for postoperative patients with foot drop caused by lumbar degenerative disease

目的 :分析腰椎退变性疾病致足下垂手术治疗结果 ,探讨手术治疗的预后影响因素。方法 :回顾分析2011年1月~2016年1月手术治疗的2341例腰椎退变性疾病患者,其中因腰椎间盘突出症或腰椎管狭窄症致足下垂者125例,108例完成完整随访并纳入研究。手术均采取腰椎后路、神经根减压、椎弓根螺钉内固定、椎间融合术治疗。术后随访1.4~5.2年,平均2.4±1.5年,以胫前肌肌力恢复至4或5级,患者可背伸足踝,步态基本正常,为治愈。收集患者年龄、性别、腰椎退变性质、足下垂病程、术前胫前肌肌力、受累肢体的数量、患肢感觉障碍、术前疼痛VAS评分、马尾综合征、外伤史、受累节段等指标,应用Log-rank检验进行单因素分析,并采用Cox回归分析患者手术治疗的预后影响因素。结果:108例患者,治愈59例,治愈率为54.6%。其中腰椎管狭窄症44例,治愈15例,治愈率为34.1%;腰椎间盘突出症64例,治愈44例,治愈率为68.7%。单因素分析结果示,年龄、腰椎退变性质、足下垂的病程、术前胫前肌肌力、受累肢体数量与足下垂的预后显著相关(P<0.05)。Cox回归分析结果显示,年龄、腰椎退变性质、病程、术前胫前肌肌力是足下垂患者术后预后的独立影响因素(P<0.05)。结论 :在腰椎退变性疾病致足下垂患者中,年龄、腰椎退变性质、病程、术前胫前肌肌力与足下垂患者的预后显著相关;年龄越小、病程越短、术前胫前肌肌力强者预后较好;腰椎间盘突出症较腰椎管狭窄症导致的足下垂者预后好。

Objectives： To analyze the clinical result and the prognostic factors for postoperative patients with foot drop caused by lumbar degenerative disease. Methods： 2341 patients who suffered from lumbar degenerative disease and underwent lumbar surgery from January 2011 to January 2016 were reviewed, among which 125 cases suffered from foot drop and caused by lumbar spinal stenosis（LSS） or lumbar disc herniation（LDH）. Among the 125 patients, 108 cases were enrolled with complete follow-up. All patients underwent modified PLIF and nerve roots decompression. The mean follow-up period was 2.4±1.5 years（range, 1.4-5.2 years）. Patients whose tibialis anterior（TA） muscle strength recovered to grade 4 or grade 5, the ankle could move freely, with a relative normal gait, could be considered as recovery. The following indexes were included in the single factor analysis by Log-rank test： age, gender, type of lumbar degeneration, duration of palsy, preoperative tibialis anterior strength, physical sensation disorder of affected lower limbs, number of affected limbs, preoperative VAS score, cauda equine syndrome, affected levels and history of trauma. Cox regression analysis was used to analyze the prognostic factors of surgical treatment effect. Results： Among 108 cases of patients with foot drop, 59 cases were cured, the recovery rate was about 54.6%. Among them, 44 cases were LSS, and 15 cases were cured, the rate was 34.1%; 64 cases were LDH, 44 cases were cured, the rate was 68.7%. The single factor analysis showed that age, type of lumbar degeneration, duration of palsy, preoperative TA muscle strength and number of affected limbs had significant relation with prognosis（P〈0.05）. The Cox regression analysis showed the following indexes were the prognostic factors of foot drop： age, type of lumbar degeneration, duration of palsy and preoperative TA muscle strength（P〈0.05）. Conclusions： Age, type of degeneration, duration of palsy and preoperative TA muscle strength are significantly related to the prognosis of foot drop caused by lumbar degenerative disease. Patiets with younger age, shorter duration, stronger TA muscle strength recover better; compared with LSS, foot drop caused by LDH recover better.