单开门椎板成形钢板内固定术后轴性疼痛相关因素分析

Analysisof related factors of axial pain after single-door laminectomy with formed steel plate internal fixation

目的探讨单开门椎板成形钢板内固定术后轴性疼痛的危险因素。方法纳入2014年4月~2017年4月行单开门椎板成形钢板内固定术治疗的135例患者,根据术后是否出现轴性疼痛设为观察组与对照组。调查两组患者年龄、性别、术前影像学资料等,并经单因素分析以及Logistic回归分析调查轴性疼痛的独立危险因素。结果135例患者术后发生轴性疼痛40例,发生率29.63%;两组患者颈椎活动度变化、术前颈椎曲度、术中关节突关节破坏、C7棘突肌肉止点破坏、手术节段数、手术时间、出血量差异有统计学意义(P<0.05);Logistic回归分析显示,颈椎活动度变化>15°(OR=2.711)、术前颈椎曲度<12°(OR=3.368)、术中关节突关节破坏(OR=2.266)、C7棘突肌肉止点破坏(OR=2.321)是单开门椎板成形钢板内固定术后轴性疼痛的独立危险因素。结论单开门椎板成形钢板内固定术后轴性疼痛发生率较高,颈椎活动度变化、术前颈椎曲度、术中破坏关节突关节、C7棘突肌肉止点等均会增加其发生风险。

Objective To study the risk factors of axial pain after cervical spinal canal stenosis treated by single-door laminectomy with formed steel plate internal fixation.Methods A total of 135 patients with cervical spinal stenosis admitted to our hospital from April 2014 to April 2017 were selected in this study.All patients underwent single-door laminectomy with formed steel plate internal fixation.According to whether there was axial pain after operation,the patients were divided into the observation group and the control group.The age,sex,preoperative imaging data of the two groups were investigated.The independent risk factors for axial pain were investigated by univariate analysis and Logistic regression analysis.Results Forty cases of axial pain occurred in 135 patients with cervical spinal stenosis after operation,the incidence rate was 29.63%.There were significant differences in cervical vertebra activity changes,preoperative cervical curvature,intraoperative facet joint destruction,C7 spinous process muscle endpoint destruction,number of surgical segments,operation time and bleeding volume between the observation group and the control group(P<0.05).Logistic regression analysis showed that cervical vertebra activity changes>15°(OR=2.711),preoperative cervical curvature<12°(OR=3.368),intraoperative facet joint destruction(OR=2.266),C7 spinous process muscle endpoint destruction(OR=2.321)were independent risk factors for the axial pain after cervical spinal canal stenosis treated by single-door laminectomy with formed steel plate internal fixation.Conclusion Single-door laminectomy with formed steel plate internal fixation in the treatment of cervical spinal canal stenosis has higher incidence of axial pain,and the cervical vertebra activity changes,preoperative cervical curvature,intraoperative facet joint destruction,C7 spinous process muscle endpoint destruction will increase the risk of it.