摘要
目的对腰椎管狭窄症(lumbar spinal stenosis,LSS)患者术后行走能力进行评价,并分析其相关预测因素。方法随机选择湖北医药学院附属十堰市太和医院骨科于2017年3月~2019年10月拟开展后路手术的LSS患者93例,均接受后路椎板间开窗减压术或减压融合术。对所有患者术后随访6月,评价其手术疗效和术后行走能力[采用6 min步行距离(6-minute walking distance,6MWD)进行测试]。统计患者的人口学资料、临床特征资料、基础疾病、手术相关资料等指标数据。对上述资料与术后6MWD的相关性进行Pearson分析,同时构建多重线性回归分析以确定其预测因素,并建立预测方程。结果93例中,除去失访、再次手术和术后外伤、主动退出等被剔除者之外,最终纳入72例有效样本。相比于术前,72例患者术后6个月时的腰痛、下肢痛和下肢麻木VAS评分均显著改善,功能障碍ODI指数显著降低,术后躯干伸屈肌力均有显著提高,6MWD也显著增加,差异均有统计学意义(P<0.05)。经Pearson相关性检验,术后6MWD与术前6MWD、年龄、身高、体重、下肢痛和麻木、躯干肌屈伸肌力有显著相关性(P<0.01)。经调整后的多重线性回归模型(R^(2)=0.65)验证,年龄(β=-0.45)、体重(β=-0.20)、手术类型(β=-0.32)、手术节段(β=-0.28)和术前躯干伸肌肌力(β=0.26),均为术后6MWD相关的术前预测因素(P<0.05或P<0.001),同时据此构建了预测方程。结论LSS患者术后行走能力的相关因素较多,年龄越小、体重越轻、单节段手术、单纯减压手术、躯干伸肌肌力较好、术前6MWD较好者,术后6MWD也较好。
Objective To evaluate the walking ability of patients with lumbar spinal stenosis(LSS)after operation and analyze the related predictive factors.Methods From March 2017 to October 2019,93 patients with LSS were randomly selected,and all of them received posterior laminectomy or decompression fusion.All patients were followed up for 6 months to evaluate the surgical efficacy and postoperative walking ability[6-minute walking distance(6MWD)was used to test].The demographic data,clinical characteristics,basic diseases,operation related data and other indicators of patients were observed.Pearson analysis was used to analyze the correlation between the above data and postoperative 6MWD,and multiple linear regression analysis was performed to determine the predictive factors and establish the predictive equation.Results In 93 cases,72 effective samples were finally included except those who were excluded such as loss of follow-up,reoperation,postoperative trauma and active withdrawal.Compared with before operation,the VAS scores of low back pain,lower limb pain and lower limb numbness of 72 patients at 6 months after operation were significantly improved,the ODI index of dysfunction was also significantly reduced,the trunk extension and flexion muscle strength were significantly improved,and the 6MWD was also significantly increased(P<0.05).Pearson correlation test showed that postoperative 6MWD was significantly correlated with preoperative 6MWD,age,height,weight,lower limb pain and numbness,trunk muscle flexion and extension strength(P<0.01).The adjusted multiple linear regression model(R^(2)=0.65)verified that age(β=-0.45),body weight(β=-0.20),type of operation(β=-0.32),surgical segment(β=-0.28)and preoperative trunk extensor muscle strength(β=0.26)were the preoperative predictors of postoperative 6MWD(P<0.05 or P<0.001),and the predictive equation was constructed accordingly.Conclusion There are many factors related to the walking ability of LSS patients after operation,such as younger age,lighter weight,single segment operation,simple decompression operation,better trunk extensor muscle strength,better 6MWD before operation,and better 6MWD after operation.
作者
牛聚伟
刘义
NIU Ju-wei;LIU Yi(Department of Orthopedics,Taihe Hospital of Shiyan City Affiliated to Hubei Medical College,Shiyan,Hubei 442000,China)
出处
《颈腰痛杂志》
2022年第1期10-14,共5页
The Journal of Cervicodynia and Lumbodynia
基金
国家自然科学基金(编号:81301587)。
关键词
腰椎管狭窄症
行走能力
手术预后
预测因素
lumbar spinal stenosis
walking ability
surgical prognosis
predictive factors
作者简介
牛聚伟(1980-),男,湖北籍,主治医师,硕士,研究方向:骨外科,电子邮箱:54765519@qq.com。
