腰椎滑脱术后健康相关生活质量评分最小临床重要差异的相关因素分析

Analysis of the correlation factors of the MCID in healthrelated quality of life score after lumbar spondylolisthesis

目的:分析峡部裂性腰椎滑脱(IS)病人术后健康相关生活质量评分最小临床重要差异(MCID)的相关因素。方法:选取接受经椎间孔腰椎椎体间融合术内固定融合术的轻度单节段IS病人74例,术后随访24~49个月,将MCID定义为术后Oswestry功能障碍指数(ODI)改善>12和疼痛视觉模拟评分(VAS)腰痛及腿痛评分改善>3分。根据病人术后以上项目评分改善情况,将病人分为达到MCID组(A组)和未达到MCID组(N组)。比较2组病人在不同评分项目下一般资料、影像学参数和术后并发症情况。结果:74例病人ODI、VAS腰痛和VAS腿痛改善评分达到MCID比例分别为81.1%、79.7%和73.0%。不同评分项目(ODI、VAS腰痛评分、VAS腿痛评分)下,2组病人年龄、性别差异均无统计学意义(P>0.05);VAS腰痛评分项下,2组病人手术节段差异无统计学意义(P>0.05),ODI和VAS腿痛评分项下,2组病人的手术节段差异均有统计学意义(P<0.05)。2组病人术前各项影像学参数差异均无统计学意义(P>0.05)。术后,VAS腿痛评分项下A组病人椎间盘高度高于N组(P<0.05),节段性前凸低于N组(P<0.05);ODI评分下A组病人节段性前凸低于N组(P<0.05);其他影像学参数差异均无统计学意义(P>0.05)。2组病人各项并发症发生情况差异均无统计学意义(P>0.05)。结论:对于行经椎间孔腰椎椎体间融合术内固定融合术的IS病人,合适的椎间盘高度重建较之取得更大的节段性前凸或者提高复位率可能更有意义。

Objective:To analyze the related factors of the minimal clinically important difference(MCID)in healthrelated quality of life score after isthmic spondylolisthesis(IS).Methods:A total of 74 low-grade IS patients treated with transforaminal lumbar interbody fusion(TLIF)internal fixation fusion were investigated,and followed up for 24 to 49 months.The postoperative Oswestry disability index(ODI)improvement>12 scores and visual analogue scale(VAS)score of lower back pain and leg pain improvement>3 scores were defined as the MCID.The patients were divided into MCID group(group A)and no reaching MCID group(group N)according to the improvement scores of the above items.The general data,imaging parameters and postoperative complications were compared between two groups.Results:The proportions of the improvement scores of ODI,VAS back pain and VAS leg pain achieving the MCID were 81.1%,79.7%and 73.0%,respectively.The differences of the age and sex in different scores of ODI,VAS back pain and VAS leg pain between two groups were not statistically significant(P>0.05).Under the VAS score of low back pain,the difference of operative segment between two groups was not statistically significant(P>0.05),and under the ODI and VAS leg pain score,the difference of operative segment between two groups was statistically significant(P<0.05).There was no statistical significance in preoperative imaging parameters between two groups(P>0.05).After surgery,the disc height in group A was higher than that in group N(P<0.05),and the segmental lordosis in group A was lower than that in group N(P<0.05).Under the ODI score,the segmental lordosis in group A was lower than that in group N(P<0.05).There was no statistical significance in other imaging parameters between two groups(P>0.05).There was no statistical significance in the incidence of complications between two groups(P>0.05).Conclusions:For low-grade IS patients treated with TLIF,The appropriate disc height reconstruction may be more significant than achieving greater segmental lordosis or increasing reduction rate for low-grade IS patients.