后路减压融合术后持续腰痛的发生率及危险因素

Incidence and risk factors of persistent low back pain subsequent to posterior decompression and instrumented fusion for lumbar disc herniation

[目的]探讨后路减压植骨融合内固定治疗腰椎间盘突出症术后持续腰痛(PLBP)的发生率及危险因素分析。[方法]回顾性分析2015年1月2017年12月于本院接受腰椎后路减压植骨融合内固定术的腰椎间盘突出症患者123例。在所有随访时间点,包括术后3、6和12个月,疼痛NRS评分>50的患者判定为PLBP。记录PLBP发生情况,比较PLBP组与非PLBP组的临床与影像资料,采用多元logistic回归分析PLBP发生的危险因素。[结果]123例患者中,11例判定为PLBP,占8.94%;其余112例患者为非PLBP,占91.06%。两组患者在年龄、性别、BMI、合并症、吸烟和饮酒、手术时间、术中失血量、手术方式、融合节段数量、切口大小、术前LL、矫正LL、术前腰椎活动度和Modic改变方面的差异无统计学意义(P>0.05)。但是,PLBP组术前腰痛NRS评分显著高于非PLBP组(P<0.05);PLBP组L5 S1节段手术占比显著高于非PLBP组(P<0.05);PLBP组的术前椎旁肌FIR显著大于非PLBP组(P<0.05)。多元logistic回归分析显示术前NRS评分、手术节段和术前椎旁肌FIR是PLBP的危险因素。[结论]腰椎间盘突出症后路减压植骨融合内固定术后PLBP的发生率为8.94%,其危险因素包括术前腰痛、手术节段为L5 S1和术前椎旁肌退变。

[Objective] To explore the incidence and risk factors of persistent low back pain(PLBP) subsequent to posterior decompression combined with instrumented fusion for lumbar disc herniation. [Methods] A retrospective study was conducted on 123 patients who underwent posterior decompression combined with instrumented fusion for lumbar intervertebral disc herniation from January 2015 to December 2017. If the patient marked numeric rating scale(NRS) for pain more than 50 at all the time points of follow up, including 3, 6 and 12 months postoperatively, the PLBP was determined. The occurrence of PLBP was documented, and the risk factors were searched by univariate and multivariate analysis. [Results] Of the 123 patients, 11 patients were determined as PLBP accounted for 8.94%, while the remaining 112 patients were of non-PLBP accounted for91.06%. In term of univariate analysis, there were no significant differences between the two groups regarding the personal characteristics, such as age, gender, BMI, smoking, alcohol consumption and comorbidities of internal diseases;the parameters related to surgery including operation time, incision length, intraoperative blood loss, surgical techniques, number of segments fused;as well as the radiographic measurements including preoperative lumbar lordosis(LL), preoperative local lumbar range of motion, correction of LL and extent of Modic changes(P>0.05). However, the PLBP group had significantly higher preoperative NRS, significantly greater ratio of the L5 S1 segment affected and significantly more severe fatty infiltration rate(FIR) of paravertebral muscles than the non-PLBP group(P<0.05). As results of multiple binary logistic regression analysis, the greater preoperative NRS for low back pain, surgery segment and preoperative more severe FIR of paravertebral muscles were independently factors related to postoperative PLBP. [Conclusion] The incidence of PLBP is 8.94% subsequent to posterior decompression and instrumented fusion for lumbar disc herniation. The risk factors might be the extent of preoperative low back pain, and magnitude of preoperative paravertebral muscle degeneration.