成人重度腰椎滑脱复位术后发生神经根性疼痛的危险因素分析  

Risk factors analysis of neurogenic pain after adult high grade lumbar spondylolisthesis reduction surgery

作　　者：曾浪 杨彦 姜力元 吴建煌[1] 胡建中[1] 吴天定[1] Zeng Lang;Yang Yan;Jiang Liyuan;Wu Jianhuang;Hu Jianzhong;Wu Tianding(Department of Spine Surgery and Orthopaedics,Xiangya Hospital of Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院脊柱外科,长沙410008

出　　处：《中华骨科杂志》2024年第13期866-873,共8页Chinese Journal of Orthopaedics

基　　金：湖南省自然科学基金(2024JJ5614)。

摘　　要：目的:探讨腰椎滑脱的弓弦比值(lumbar bowstring ratio,LBR)及脊柱-骨盆矢状面参数对成人重度腰椎峡部裂型滑脱复位术后神经根性疼痛的危险因素。方法:回顾性分析2012年8月至2023年1月于中南大学湘雅医院脊柱外科接受手术治疗成人重度腰椎峡部裂型滑脱患者的临床及影像学资料,获得至少6个月随访的95例患者纳入研究。根据患者术后是否出现持续性根性疼痛≥8周且疼痛视觉模拟评分(visual analogue scale,VAS)>3分进行分组,即疼痛组和非疼痛组。疼痛组15例,男5例、女10例,年龄(55.47±6.42)岁(范围46~71岁);非疼痛组80例,男20例、女60例,年龄(60.98±11.50)岁(范围40~85岁)。临床疗效评估采用Oswestry功能障碍指数(Oswestry disability index,ODI)和VAS评分。腰椎LBR定义为L_(1)~L_(5)前纵韧带为弓线,L 1椎体后上缘与S_(1)椎体后缘连线距离为弦线,弓线前凸顶点至弦线的垂直距离与弦线的比值。测量脊柱-骨盆参数包括骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、腰椎前凸角(lumbar lordosis,LL)、PT/SS和手术前后LBR变化值(ΔLBR)。比较两组患者的一般资料及影像学测量参数,差异有统计学意义的变量纳入二分类logistic回归分析,确定成人重度腰椎滑脱复位内固定术后神经根性疼痛的独立危险因素。结果:所有95例患者滑脱均获得完全解剖复位,切口一期愈合,无发生切口感染病例,术后随访时间为(7.68±2.98)个月(范围6~12)个月。术后95例患者出现15例医源性神经根性疼痛。术后并发症包括肺部感染4例(疼痛组1例、非疼痛组3例),脑脊液漏8例(疼痛组2例、非疼痛组6例),谵妄5例(疼痛组2例、非疼痛组3例)。两组一般资料的差异无统计学意义(P>0.05)。术后6个月随访时两组患者ODI(疼痛组Z=-3.413,P=0.001;非疼痛组Z=-7.772,P<0.001)和VAS评分(疼痛组Z=-3.426,P=0.001;非疼痛组Z=-7.838,P<0.001)�Objective To evaluate the significance of the lumbar bowstring ratio(LBR)and sagittal spine-pelvis parameters in predicting postoperative neurogenic pain in adult patients with high-grade lumbar isthmic spondylolisthesis following spinal fusion surgery.Methods A retrospective analysis was conducted on the clinical and imaging data of 95 adult patients with high-grade lumbar isthmic spondylolisthesis treated by spinal surgery at Xiangya Hospital of Central South University from August 2012 to January 2023.Each patient was followed for a minimum of six months.Participants were categorized into pain and non-pain groups based on the presence of persistent radicular pain(≥8 weeks)and a visual analogue scale(VAS)score of≥3 postoperatively.The pain group comprised 15 patients(5 males,10 females;mean age 55.47±6.42 years,range 46-71 years),while the non-pain group included 80 patients(20 males,60 females;mean age 60.98±11.50 years,range 40-85 years).Clinical outcomes were assessed using the Oswestry Disability Index(ODI)and VAS scores.LBR was defined as the ratio of the vertical distance from the anterior convexity of the L_(1)-L_(5) anterior longitudinal ligament to a line connecting the posterior superior margin of the L1 vertebra and the posterior margin of the S1 vertebra,to the distance between these two points.Spinal-pelvic parameters measured included pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),lumbar lordosis(LL),PT/SS ratio,and changes in LBR before and after surgery(ΔLBR).Statistical comparisons of demographic and imaging parameters were performed between the two groups,and variables showing significant differences were subjected to binary logistic regression analysis to identify independent risk factors for postoperative neurogenic pain.Results All 95 patients achieved complete anatomical reduction of the dislocation without reported wound infections.Follow-up was completed at 7.68±2.98 months(range 6-12 months)postoperatively.Among the patients,15 developed iatrogenic radicular pain.Postoper

关 键 词：腰椎 脊椎滑脱 脊柱融合术 手术后并发症 复位 脊柱-骨盆矢状面参数 

分 类 号：R687.3[医药卫生—骨科学]