脊柱内镜治疗腰椎管狭窄症术后短期疗效欠佳的因素分析

Analysis of the Factors of Qoor Short-Term Efficacy of Spinal Endoscopy in the Treatment of Lumbar Spinal Stenosis

目的:对导致腰椎管狭窄症(lumbar spine stenosis,LSS)患者通过脊柱内镜技术治疗后短期疗效欠佳的不良因素进行分析。方法:回顾性的分析2016年10月至2019年2月在广西中医药大学第一附属医院接受经皮脊柱内镜腰神经根减压术(percutaneous endoscopic lumbar decompression,PELD)的治疗的LSS患者160例的临床资料,运用改良MacNab疗效评定标准对患者进行疗效评估,将患者分为预后不良组(n=12例)和预后优良组(n=148例),采用单因素和二次Logistic回归分析探讨造成LSS患者术后短期内疗效欠佳的危险因素。结果:LSS患者PELD术后短期预后不良率为7.5%(12/160)。预后不良组中年龄>60岁、合并糖尿病史、狭窄类型为腰椎间盘突出、功能锻炼时间较短、合并骨质疏松症、重体力劳动者患者构成比均显著高于预后优良组(均P<0.05)。二次Logistic回归分析显示:年龄>60岁、合并糖尿病史、有吸烟史、功能锻炼时间较短、合并骨质疏松症、重体力劳动者是导致LSS患者PELD术后短期疗效欠佳的因素(OR=1.342、2.182、1.226、7.626、2.565、1.594、45.179,均P<0.05)。结论:目前PELD是治疗LSS的重要及有效的方法之一,但是造成其手术后短期疗效欠佳不良因素较多,值得临床广泛重视,同时需要积极采取针对性措施,以进一步提高患者术后短期疗效。

Objective:To analyze the adverse factors that led to the short-term poor efficacy of LSS patients treated with spinal endoscopy.Methods:To retrospectively analyze the clinical data of 160 LSS patients who received PELD in the First Hospital of Guangxi University of Traditional Chinese Medicine from October 2016 to February 2019,the improved MacNab efficacy evaluation standard was used to evaluate the efficacy of the patients,the patients were divided into poor prognosis group(n=12 cases)and excellent prognosis group(n=148 cases).The single factor and secondary logistic regression analysis were used to investigate the risk factors for poor short-term postoperative outcomes in LSS patients.Results:The short-term poor prognosis rate of LSS patients after PELD was 7.5%(12/160).In the poor prognosis group,the proportion of patients with age>60 years,had a history of diabetes,type of stenosis was lumbar disc herniation,short time of functional exercise,combined with osteoporosis,and the proportion of patients with heavy manual labor were significantly higher than those with excellent prognosis group(both P<0.05).Secondary logistic regression analysis showed that:age>60 years,history of diabetes,history of smoking,short time of functional exercise,combined with osteoporosis,and heavy manual labor are factors that cause poor short-term efficacy after PELD in LSS patients(OR=1.342,2.182,1.226,7.626,2.565,1.594,45.179,all P<0.05).Conclusion:At present,PELD is one of the important and effective methods for the treatment of LSS,but there are many adverse factors causing poor short-term postoperative efficacy,which deserve extensive clinical attention.Meanwhile,targeted measures should be taken actively to further improve the short-term postoperative efficacy of patients.