腰椎间盘突出症开放手术后下腰痛症状加重的发生率及危险因素分析  

Low back pain aggravation after decompressive surgery for lumbar disc herniation: incidence and risk factors

作　　者：周信 李湛然 马京星 陈胜敏[2] 王辉[2] ZHOU Xin;LI Zhanran;MA Jingxing;CHEN Shengmin;WANG Hui(Department of Orthopedics,Xinle City Hospital,Xinle 050700,China;Department of Spine Surgery,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]新乐市医院骨科,河北新乐050700 [2]河北医科大学第三医院脊柱科,河北石家庄050051

出　　处：《大连医科大学学报》2024年第4期302-307,共6页Journal of Dalian Medical University

基　　金：河北省自然科学基金项目(H2022206056);河北省卫生健康委员会科研基金项目(20190656)。

摘　　要：目的 探讨腰椎间盘突出症开放手术后下腰痛加重的发生率并分析其危险因素。方法 回顾分析2010年1月至2022年12月期间行开放手术治疗的227例腰椎间盘突出症患者的临床及影像学资料,依据术后1年随访时下腰痛数字评定量表(NRS)评分相比于术前的变化情况分为疼痛加重组(评分增加超过5分)和疼痛缓解组(评分减小超过5分)。比较两组患者的一般资料(年龄、性别、体重指数、术前腰痛、合并症、吸烟、饮酒)、手术资料(手术方式、手术节段、融合程度、手术时间、失血量、切口大小)和影像学资料[腰椎前凸角、腰椎前凸矫正、Modic改变、椎旁肌脂肪浸润率(FIR)]。分析术后下腰痛加重的危险因素。结果 疼痛加重组31例,疼痛缓解组196例,下腰痛加重的发生率为13.6%。疼痛加重组的术前腰痛NRS评分,L5~S1节段手术的占比,椎旁肌FIR及Modic变化发生率均高于疼痛缓解组(P<0.05)。二分类Logistic回归分析显示,术前腰痛NRS评分、L5~S1节段手术、椎旁肌FIR与术后下腰痛加重有关。进一步绘制ROC曲线显示,NRS评分> 56分术后下腰痛加重的风险更大(AUC=0.913,灵敏性=0.839,特异性=0.923)。椎旁肌FIR>40%术后下腰痛加重的风险更大(AUC=0.890,灵敏性=0.746,特异性=0.944)。结论 腰椎间盘突出症开放手术后1年出现下腰痛加重的发生率为13.6%,术前腰痛NRS评分、L5~S1节段手术和椎旁肌FIR与腰椎间盘突出症开放手术后下腰痛加重关系密切。Objective To investigate the incidence of exacerbated lower back pain after open surgery for lumbar disc herniation and analyze the associated risk factors. Methods A retrospective analysis was conducted on the clinical and imaging data of 227 patients with lumbar disc herniation who underwent open surgery between January 2010 and December 2022. Based on the changes in the numerical rating scale(NRS) for lower back pain during the one-year follow-up after surgery compared to preoperative scores, patients were divided into two groups: pain exacerbation group(score increase of more than 5 points) and pain relief group(score decrease of more than 5 points). General information(age, gender, body mass index, preoperative low back pain, comorbidities, smoking, alcohol consumption), surgical data(surgical method, surgical segment, degree of fusion,surgical time, blood loss, incision size), and imaging data(lumbar lordosis angle, lumbar lordosis correction, Modic changes,and paraspinal muscle degeneration) were compared between two groups of patients. Results There were 31 cases in pain exacerbation group and 196 cases in pain relief group. The incidence of worsening lower back pain was 13.6%. The preoperative lower back pain NRS score, the proportion of L5-S1 surgical segments, the incidence of paravertebral muscle fat infiltration rate(FIR), and the incidence of Modic changes were higher in pain exacerbation group than those in pain relief group(P<0.05).Binary logistic regression analysis showed that preoperative lower back pain NRS, L5-S1 segment surgery, and paraspinal muscle FIR were associated with postoperative exacerbation of lower back pain. Further ROC curve analysis indicated that an NRS score>56 posed a greater risk of postoperative exacerbated lower back pain(AUC=0.913, sensitivity=0.839, specificity=0.923).The risk was also higher for paraspinal muscle FIR>40%(AUC=0.890, sensitivity=0.746, specificity=0.944). Conclusions The incidence of worsening lower back pain one year after open surgery for lumbar disc

关 键 词：下腰痛 后路手术 腰椎间盘突出症 

分 类 号：R68[医药卫生—骨科学]