腰椎管狭窄症患者经椎间孔镜治疗后下腰痛的影响因素分析

Analysis of Influencing Factors of Low Back Pain in Patients with Lumbar Stenosis Treated with Percutaneous Endoscopic Lumbar Discectomy

目的分析腰椎管狭窄症患者经椎间孔镜治疗后下腰痛的影响因素。方法选取医院2018年1月-2019年12月收治的腰椎管狭窄症患者180例,将74例腰椎管狭窄症患者经椎间孔镜治疗后下腰痛患者纳入观察组,未发生下腰痛的患者106例纳入对照组。两组患者接受经椎间孔镜治疗,由同一手术医生、麻醉师操作。术后统计两组患者下腰疼痛情况。问卷调查两组患者性别、年龄、手术时间、出血量、吸烟、围绝经期综合征、术后关节疾病、手术入路、高血压、融合节段、饮酒情况。结果两组患者年龄、手术入路、糖尿病、高血压、融合节段数、饮酒差异比较无统计学意义(P>0.05),观察组患者女性、手术时间、出血量、围绝经期综合征、邻近关节疾病、吸烟高于对照组(P<0.05)。经Spearman相关性分析得出性别(r=0.150)和邻近关节疾病(r=0.250)与腰椎管狭窄症患者经椎间孔镜治疗后下腰痛呈正相关性(P<0.05),手术时间(r=-0.147)、出血量(r=-0.311)和围绝经期综合征(r=-0.382)与腰椎管狭窄症患者经椎间孔镜治疗后下腰痛呈负相关性(P<0.05),吸烟(r=-0.117)与腰椎管狭窄症患者经椎间孔镜治疗后下腰痛呈无相关性(P>0.05)。经ROC曲线分析,围绝经期综合征具有较高的预测性,AUC为0.683,显著高于性别(AUC=0.563)、吸烟(AUC=0.558),而与手术时间(AUC=0.605)、出血量(AUC=0.657)和邻近关节疾病(AUC=0.624)之间没有较大的差异。结论腰椎管狭窄症患者经椎间孔镜治疗后下腰痛的影响因素较多,围绝经期综合征、邻近关节疾病、吸烟会促进术后下腰痛发生,建议临床积极干预。

Objective To investigate the influencing factors of low back pain in patients with lumbar stenosis treated with percutaneous endoscopic lumbar discectomy.Methods 180 patients with lumbar discectomy in our hospital from January 2018 to December 2019 were enrolled,and divided into two groups according to the presence or absence of lower back pain,observation group(n=74)and control group(n=106).The operation in both groups was carried out by same team.Various indexes were recorded in both groups after operation,including lower back pain rate,gender,age,operation time,blood loss amount,smoking,perimenopausal syndrome,postoperative joint disease,surgical approach,hypertension,fusion segment and alcohol consumption.Results The age,surgical approach,diabetes,hypertension,number of fusion segments,and alcohol consumption had significant difference between groups(P>0.05).The ratio of female,operation time,blood loss amount,perimenopausal syndrome,adjacent joint disease,and smoking was higher in observation group than in control group(P<0.05).Spearman correlation analysis showed that gender(r=0.150)and adjacent joint diseases(r=0.250)were positively correlated with low back pain after lumbar spinal stenosis treatment(P<0.05),while operation time(r=-0.147),blood loss amount(r=-0.311)and perimenopausal syndrome(r=-0.382)were negatively correlated with low back pain after lumbar spinal stenosis treatment(P<0.05),and smoking showed no significant correlation with low back pain after lumbar spinal stenosis treatment(P>0.05).ROC curve analysis showed that perimenopausal syndrome was highly predictive value,with an AUC of 0.683,which was significantly higher than that of gender(AUC=0.563)and smoking(AUC=0.558).The ACU showed no significant difference among operation time(AUC=0.605),blood loss(AUC=0.657)or adjacent joint disease(AUC=0.624).Conclusion Low back pain in patients with lumbar stenosis treated with percutaneous endoscopic lumbar discectomy is influenced by various factors,and perimenopausal syndrome,adjacent joint disease,and smoking will promote the occurrence of low back pain after surgery.