退行性腰椎管狭窄症患者术后不良结局的潜在预测因素

The potential predictors of poor postoperative outcomes in patients with degenerative lumbar spinal stenosis

目的探讨退行性腰椎管狭窄症(lumbar spinal stenosis,LSS)患者行减压手术后出现不良结局的风险因素。方法纳入2017年3月~2019年3月在本科开展减压手术治疗的137例LSS患者,依据术后12个月时的VAS评分、ODI指数改善情况进行术后结局(包括下肢痛结局和总体转归情况)的判定:VAS评分降低程度≥30%、术后ODI指数<22%或ODI降低程度≥50%,判定为结局良好;不满足该条件,则判定为结局不良。统计所有患者的人口学资料、临床资料和手术资料预测因素,采用单因素分析和多因素Logistic回归分析筛选出相关风险因素。结果137例中,下肢痛的结局良好者101例(73.7%),结局不良36例(26.3%);总体转归的结局良好者98例(71.5%),结局不良39例(28.5%)。单因素分析显示,定期锻炼、有理疗史、合并抑郁症、症状持续时间等因素,是下肢痛和总体转归不良结局的共同潜在相关因素(P<0.05);有脊柱手术史和应用抗惊厥药物也是术后下肢痛转归不良的潜在风险因素(P<0.05)。经Logistic回归分析:定期锻炼(OR=0.292,0.337)、有理疗史(OR=0.024,0.026)均是LSS患者术后下肢痛或总体结局转归不良的独立保护因素,而合并抑郁症(OR=2.391,4.335)、症状持续时间(OR=3.527,3.618)均是二者的独立风险因素;有脊柱手术史(OR=5.043)、有应用抗惊厥药物(OR=3.493)也是术后下肢痛转归不良的独立风险因素。结论LSS患者减压手术后的下肢痛或总体结局转归不良与多种因素有关,合并抑郁症、症状持续时间久均是共同的独立风险因素;术前使用抗惊厥药物和脊柱手术史也是下肢痛转归不良的独立风险因素;而定期锻炼、有理疗史均是二者共同的独立保护因素。

Objective To investigate the risk factors for poor outcomes after decompressive surgery in patients with degenerative lumbar spinal stenosis(LSS).Methods A total of 137 LSS patients who underwent decompressive surgery in our department from March 2017 to March 2019 were included in the study,and postoperative outcomes(including lower extremity pain outcomes and overall outcomes)were determined based on the improvement of VAS score and ODI index 12 months after surgery.The decision of:the degree of reduction of VAS score≥30%,the postoperative ODI index<22%or the degree of reduction of ODI≥50%,was judged to be a good outcome;if the condition was not met,the outcome was judged to be poor.The potential predictors such as demographic data,clinical data,and surgical data of all patients were counted,and the relevant risk factors were screened by using univariate analysis and multivariate logistic regression analysis.Results Of 137 patients,101(73.7%)had a favorable outcome and 36(26.3%)had a poor outcome for lower extremity pain,and 98(71.5%)had a favorable outcome and 39(28.5%)had a poor outcome.On univariate analysis,regular exercise,a history of physiotherapy,comorbid depression,and duration of symptoms were all common potential risk factors for worse outcomes in terms of lower extremity pain and overall outcomes(P<0.05).Furthermore,having a history of spinal surgery and taking anticonvulsant medications were potential risk factors for worse outcomes in terms of lower extremity pain after surgery(P<0.05).By logistic regression analysis,regular exercise(OR=0.292,0.337)and a history of physiotherapy(OR=0.024,0.026)were all independent protective factors for postoperative lower extremity pain or poor overall outcome outcomes in LSS patients,while comorbid depression(OR=2.391,4.335)and duration of symptoms(OR=3.527,3.618)were independent risk factors for both.In addition,a history of spinal surgery(OR=5.043)and having taken anticonvulsants(OR=3.493)were also independent risk factors for poor outcomes of postoperative lower extremity pain.Conclusion Lower extremity pain or poor overall outcome outcomes in patients with LSS undergoing decompressive surgery are associated with multiple factors,and comorbid depression and long duration of symptoms are common independent risk factors.Furthermore,preoperative use of anticonvulsants and history of spinal surgery are independent risk factors for poor outcome of lower extremity pain,whereas regular exercise and history of physiotherapy are both common and independently protectivefactors.