探讨退行性腰椎管狭窄减压术后并发下腰痛的影响因素  

Exploring the Influencing Factors of Low Back Pain After Degenerative Lumbar Spinal Stenosis Decompression Surgery

作　　者：汪灏 王国强 WANG Hao;WANG Guoqiang(Department of Orthopedics,Shexian County People's Hospital,Anhui 245200,China;Department of Orthopedics,Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou Zhejiang 310000,China)

机构地区：[1]安徽省歙县人民医院骨科,安徽歙县245200 [2]浙江大学医学院附属第二医院骨科,浙江杭州310000

出　　处：《临床研究》2025年第3期14-17,共4页Clinical Research

摘　　要：目的观察影响退行性腰椎管狭窄症(DLSS)患者手术后并发下腰痛(LBP)的临床危险因素。方法回顾性分析2023年7月至2023年9月于浙江大学医学院附属第二医院骨科住院治疗的退行性腰椎管狭窄的95例患者,所有患者在院期间均接受减压手术治疗,并规律随访3月,根据患者术后3月并发下腰痛(LBP)情况分为LBP组(n=34)及对照组(n=61),收集并通过单因素及多因素分析观察影响老年DLSS患者减压术后LBP的临床相关因素。结果(1)随访3个月时,DLSS患者减压术后下腰痛视觉模拟评分法(VAS)评分≥2分患者为34例,LBP发病率为35.79%(34/95);(2)两组患者吸烟史、术中清理椎间隙、术后椎管内无菌性炎症、白细胞、中性粒细胞、血沉及C反应蛋白指标比较,差异有统计学意义(P<0.05);(3)二元Logistic回归分析可知,术后存在椎管内无菌性炎症、术中未清理椎间隙、年龄>60岁及吸烟史为DLSS减压术后LBP的独立危险因素。结论影响DLSS患者减压术后LBP的危险因素包括术后存在椎管内无菌性炎症、术中未清理椎间隙、年龄>60岁及吸烟史,临床综合评估高危患者并及时干预,是改善此类患者术后预后转归的有益举措。Objective To observe the clinical risk factors affecting postoperative low back pain(LBP)in patients with degenerative lumbar spinal stenosis(DLSS).Methods A retrospective analysis was conducted on 95 DLSS patients admitted for surgery at the Department of Orthopedics of the Second Affiliated Hospital of Zhejiang University School of Medicine from July 2023 to September 2023.All patients underwent decompression surgery during hospitalization and were regularly followed up for 3 months.Based on the occurrence of postoperative LBP after 3 months,patients were divided into an LBP group(n=34)and a control group(n=61).Clinical factors related to postoperative LBP in elderly DLSS patients were collected and analyzed through univariate and multivariate analyses.Results(1)At 3 months post-surgery,34 DLSS patients had a Visual Analog Scale(VAS)score≥2 for low back pain,resulting in an LBP incidence rate of 35.79%(34/95).(2)A comparison of smoking history,intervertebral space cleaning during surgery,postoperative epidural aseptic inflammation,leukocyte count,neutrophil count,sedimentation rate,and C-reactive protein levels between the two groups showed statistically significant differences(P<0.05).(3)Binary logistic regression analysis indicated that postoperative epidural aseptic inflammation,lack of intervertebral space cleaning during surgery,age>60 years,and smoking history were independent risk factors for LBP after DLSS decompression surgery.Conclusion The risk factors influencing LBP after decompression surgery in DLSS patients include postoperative epidural aseptic inflammation,lack of intervertebral space cleaning during surgery,age>60 years,and smoking history.Comprehensive clinical assessment of high-risk patients and timely intervention is a beneficial measure to improve postoperative prognostic outcomes in these patients.

关 键 词：退行性腰椎管狭窄症 减压手术 危险因素 

分 类 号：R681.5[医药卫生—骨科学]