影响退变性腰椎滑脱融合术后远期疗效的多因素分析  

Multivariate analysis of factors affecting long-term outcomes of degenerative lumbar spondylolisthesis treated with posterior fusion

作　　者：姜欢畅[1] 王吉兴[1] 陈建庭[1] 江建明[1] 鲁凯伍[1] 瞿东滨[1] 张继业[1] 金大地[2] 

机构地区：[1]南方医科大学南方医院脊柱骨病外科,广东广州510515 [2]南方医科大学第三附属医院脊柱外科,广东广州510630

出　　处：《海南医学院学报》2011年第4期511-514,517,共5页Journal of Hainan Medical University

基　　金：海南医学院科研基金资助学报项目(0020110115)~~

摘　　要：目的：探讨可能影响退变性腰椎滑脱融合术后远期疗效的相关因素。方法：回顾性分析62例行后路减压复位融合内固定术的退变性腰椎滑脱患者59年的随访资料。以JOA评分改善率作为判断疗效的指标,并以此分为疗效优良组和疗效欠佳组。采用单因素筛选和Logistic回归分析患者年龄、性别、体重指数、合并糖尿病、病程、术前滑脱率、术前JOA评分、融合节段、融合方式、术后滑脱复位率、椎间高度增加和椎间盘角改善情况及术后随访时间等可能影响手术疗效的因素。结果：单因素分析显示影响远期疗效的因素有体重指数、病程、合并糖尿病、术前JOA评分及融合节段（P〈0.05）;Logistic回归分析表明病程和术前JOA评分对远期疗效的影响有统计学意义（P〈0.05）。结论：退变性腰椎滑脱融合术后远期疗效受多种因素影响,彻底减压、适度复位、良好融合和固定就能取得总体良好的远期疗效。Objective： To analyze factors affecting long-term outcomes of degenerative lumbar spondylolisthesis treated with posterior fusion.Methods： Retrospective study was conducted to analyze the followed up data of 62 patients with degenerative lumbar spondylolisthesis that underwent posterior fusion treatment.The followed up data ranged from 5-9 years.According to JOA scores,these patients were categorized as good outcomes group and poor outcomes group.Age,sex,body mass index（BMI）,diabetesmellitus,duration of symptoms,preoperative slippage rate and preoperative JOA score,fusion segments,fusion method,postoperative reduction rate,increase of intervertebral height and angle,as well as follow-up duration were analyzed using univariate analysis and binary logistic regression methods.Results： Univariate analysis of preoperative JOA score,duration of symptoms,diabetesmellitus,BMI and fusion segments showed significant influence on the long-term prognosis（P〈0.05）.The results of binary logistic regression indicated that preoperative JOA score and duration of symptoms were the statistically significant factors affecting clinical outcomes（P〈0.05）.Conclusions： Many factors can affect long-term outcomes of degenerative lumbar spondylolisthesis that were treated with posterior fusion.General good long-term results can been achieved through complete intraoperative decompression,fit reduction,good fusion and fixation.

关 键 词：腰椎 脊椎前移 脊柱融合术 LOGISTIC回归 

分 类 号：R687[医药卫生—骨科学] R681.53[医药卫生—外科学]