老年腰椎椎管狭窄症患者发生腰椎术后失败综合征的危险因素

Risk factors for failed back surgery syndrome in elderly patients with lumbar spinal stenosis

目的探讨老年腰椎椎管狭窄症(LSS)患者发生腰椎术后失败综合征(FBSS)的危险因素。方法回顾性分析2016年1月—2022年1月采用后路腰椎椎间融合术(PLIF)治疗的473例老年(≥65岁)LSS患者临床资料,根据是否发生FBSS分为FBSS组(n=48)和非FBSS组(n=425)。比较患者相关因素和手术相关因素在2组之间的差异,采用多因素logistic回归方法分析发生FBSS的独立危险因素。结果2组患者相关因素中受教育程度、病程、体质量指数(BMI)、瘢痕体质、高血压、糖尿病、甲状腺功能疾病、皮质醇激素使用史、术前脊柱-骨盆匹配等情况的差异均有统计学意义(P<0.05),手术相关因素中是否存在脑脊液漏、椎弓根螺钉位置、术后脊柱-骨盆匹配情况、是否佩戴支具差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,患者病程长、有瘢痕体质、有糖尿病、术前脊柱-骨盆匹配度异常、椎弓根螺钉位置靠内是FBSS发生的独立危险因素(比值比分别为2.318、4.066、3.501、4.715、5.407,P<0.05)。结论老年LSS患者病程、瘢痕体质、糖尿病、术前脊柱-骨盆匹配情况、椎弓根螺钉位置与FBSS的发生密切相关。

Objective To explore risk factors of failed back surgery syndro(meFBSS)in elderly patients with lumbar spinal stenosi(s LSS).Methods Clinical data of 473 elderly LSS patien(ts≥65 years)who were treated with posteriorl umbar interbody fusio(n PLIF)from January 2016 to January 2022 were retrospectively analyzde.The patients were divided into FBSS group(n=48)and non-FBSS group(n=425),and the differences in patient-related factors and operation-related factors between the 2 groups were compared.The multivariate lgoistic regression method was used to analyze the ris k factors for FBSS.Results The patient-related factor(s including education,disease duration,body mass inde[x BMI],scar constitution,hypertension,diabetes,thyroid function disease,history of cortisol hormone use and preoperative spinopelvi c fit)and operation-factors(including cerebrospinal fluid leakage,pedicle screw position,postoperative spinopelvic fit and brace wearing)showed statistically significant differences between the 2 gruops(P<0.05).Multivariate logistic regression analysis showed that long duration of disease,with scar constitution,with diabetes,abnormal preoperative spinopelvic fit,and inward pedicle screw position were the risk factors for oucrcrence of FBS(S odds ratio 2.318,4.066,3.501,4.715,5.407 respectively;P<0.05).Conclusion The course of disease,scar constitution,diabetes,preoperative spinopelvic fit,and postoperative pedicle screw position are significantly associaetd with the occurrence of FBSS in elderly patients with LSS.