破裂型腰椎间盘突出症转归预测因素的Logistic回归分析

Logistic regression analysis on the outcome predictive factors of ruptured lumbar disc herniation

目的:探讨破裂型腰椎间盘突出症经保守治疗后突出物的转归及预测因素。方法:选取2009年6月至2016年6月期间,对苏州市中医医院骨伤科单纯接受保守治疗的147例破裂型腰椎间盘突出症患者进行临床疗效及MRI随访。采用多因素非条件Logistic回归分析(后退逐步回归法),分析患者性别(X1)、年龄(X2)、病程(X3)、突出率(X4)、Komori分型(X5)、MSU分型(X6)、Iwabuchi分型(X7)、Pfirrmann分级(X8)、相邻椎体Modic改变(X9)、椎管形态(X10)、马尾沉降征Schizas分型(X11)共11项二分类变量与突出物吸收率的关系。结果:所有病例经随访,共发现64例突出物重吸收(吸收率≥30%),占43.5%。其中病程<1年(P=0.006)、MSU分型3型(P=0.001)、Iwabuchi分型1或5型(P=0.000)、马尾沉降征Schizas分型A型或B型(P=0.004)的患者最容易发生重吸收。回归方程Y=-10.363+1.916X3+1.446X4-1.445X5+2.070X6+4.679X7+1.125X9+1.023X10+2.223X11。而年龄、性别、Pfirrmann分级和椎管形态对突出物重吸收的影响无统计学意义。结论:破裂型腰椎间盘突出症经非手术治疗后可出现突出物的重吸收现象,其中病程<1年、MSU分型3型、Iwabuchi分型1或5型、马尾沉降征Schizas分型A型或B型的患者最容易发生重吸收,可作为突出物转归预测的关键参考因素。

Objective：To investigate the outcome predictive factors of ruptured lumbar disc herniation after conservative treatment. Methods：From June 2009 to June 2016,147 patients with ruptured lumbar intervertebral disc herniation were treated with conservative treatment in the orthopedics department of Suzhou Traditional Chinese Medicine Hospital for clinical efficacy and MRI follow up. Multivariate Logistic regression analysis（Stepwise regression method）was used to analyze the relationship between the 11 categorical variables and absorptivity of protrusions ：sex（X1）,age（X2）,course of disease（X3）,the rate of protrusion（X4）,the Komori type（X5）,the MSU type（X6）,the Iwabuchi type（X7）,the Pfirrmann grade（X8）,the Modic change on adjacent vertebrae（X9）,spinal canal morphology（X10）,the Schizas types of cauda equina sedimentation sign（X11）. Results：A total of 64 cases of prominent reabsorption among all cases followed-up（absorption rate ≥ 30%）,accounting for 43.5%. The reabsorption of protrusions is more likely to occur in patients with a duration of less than 1 year（P=0.006）,MSU type 3（P=0.001）,Iwabuchi type 1 or 5（P=0.000）,the Schizas type of cauda equina sedimentation sign A or B（P =0.004）. Regression equation Y =-10.363 ＋1.916 X3 ＋1.446 X4-1.445 X5 ＋2.070 X6 ＋4.679 X7 ＋1.125 X9 ＋1.023 X10 ＋2.223 X11. Such factors as age,gender,Pfirrmann classification and spinal canal morphology had no significant effect on reabsorption of protrusions. Conclusion：Ruptured lumbar disc herniation can be reabsorbed after nonoperative treatment. And the reabsorption of protrusions is more likely to occur in patients with a duration of less than 1 year,MSU type 3,Iwabuchi type 1 or5,the Schizas type of cauda equina sedimentation sign A or B,which can be used as the key reference factors for predicting the outcome of the projections.