退变性腰椎滑脱患者术后康复不良的影响因素分析

Analysis of the influencing factors of poor postoperative rehabilitation in patients with degenerative lumbar spondylolisthesis

目的探讨退变性腰椎滑脱(DLS)患者术后康复不良的影响因素。方法选取2015年1月至2022年1月江苏省无锡市中医医院治疗的DLS患者100例,所有患者均术后随访12个月,根据日本骨科协会评估治疗量表评分改善率分为康复不良组及康复良好组。分析DLS患者术后康复不良的影响因素。结果17例DLS患者术后康复不良,发生率为17.00%。两组年龄、多裂肌脂肪浸润Goutallier分级、远端邻近节段小关节Fujiwara分级比较,差异有统计学意义(P<0.05)。年龄、远端邻近节段小关节Fujiwara分级、多裂肌脂肪浸润Goutallier分级是DLS患者术后康复不良的影响因素(OR>1,P<0.05)。logistic回归方程为:Logit[P/(1-P)]=0.576×年龄+1.021×远端邻近节段小关节Fujiwara分级+0.887×多裂肌脂肪浸润Goutallier分级+1.154。回归方程预测DLS患者术后康复不良的曲线下面积为0.838(95%CI:0.696~0.979,P<0.05),灵敏度和特异度分别为70.60%和97.60%。结论DLS患者术后康复不良的影响因素包括年龄、远端邻近节段小关节Fujiwara分级、多裂肌脂肪浸润Goutallier分级,且联合预测对DLS患者术后下肢康复训练效果方面有一定应用价值。

Objective To explore the influencing factors of poor postoperative rehabilitation in patients with degenerative lumbar spondylolisthesis(DLS).Methods A total of 100 patients with DLS who were treated in Wuxi Traditional Chinese Medicine Hospital,Jiangsu Province from January 2015 to January 2022 were selected,all patients were followed up for twelve months after operation.According to the improvement rate of Japanese Orthopaedic Association evaluation and treatment scale,they were divided into poor rehabilitation group and good rehabilitation group.The influencing factors of poor postoperative rehabilitation in DLS patients were analyzed.Results There were 17 patients with DLS with poor postoperation rehabilitation(17.00%).There were significant differences in age,Goutallier grade of polyfidus fat infiltration,and Fujiwara grade of distal adjacent segments facet joints between two groups(P<0.05).Age,Fujiwara grade of distal adjacent segments facet joints,and Goutallier grade of polyfidus fat infiltration were the influencing factors of poor postoperative rehabilitation in DLS patients(OR>1,P<0.05).The logistic regression equation was as follows:Logit[P/(1-P)]=0.576×age+1.021×Fujiwara grade of distal segments+0.887×Goutallier grade of polyfidus fat infiltration+1.154.The area under the curve predicted postoperative poor rehabilitation by the regression equation was 0.838(95%CI:0.696-0.979,P<0.05),and the sensitivity and specificity were 70.60%and 97.60%,respectively.Conclusion The influencing factors of postoperative poor rehabilitation in DLS patients include age,Fujiwara grade of distal adjacent segments facet joints,and Goutallier grade of polyfidus fat infiltration,and it has certain application value in predicting the effect of postoperative lower limb rehabilitation training in DLS patients.