腰椎退行性疾病术后功能恢复的影响因素研究

目的:研究腰椎退行性疾病患者首次行单节段腰椎手术后功能恢复的影响因素。方法:以北京市9家三级甲等医院收治的因腰椎退行性疾病首次行单节段椎管减压内固定手术的患者为研究对象,搜集人口学资料及诊疗、随访评定记录,获得病例资料共1152例。于术前、术后24周±7天分别用日本骨科学会(Japanese Orthopedic Association,JOA)腰椎评分量表评定腰椎功能,按照功能情况分为优、良、可、差;将年龄、性别、体质指数(BMI)、手术节段、术前功能、术前疼痛、是否进行一体化康复、有无术后并发症共8个因素纳入分析,使用有序多分类logistic回归分析的方法对腰椎退行性疾病术后患者功能恢复的影响因素进行分析。结果:经过有序多分类Logistic回归分析,进行围手术期骨科康复一体化治疗的患者术后24周时腰椎JOA评分显著优于接受现行骨科诊疗的患者,差异有显著性意义(P<0.05)(OR=1.589,95% CI 0.193, 0.733]);术后无并发症的患者术后24周时腰椎JOA评分显著优于术后发生并发症的患者,差异有显著性意义(P<0.05)(OR=2.300,95% CI 0.112, 1.555])。结论:围手术期骨科康复一体化治疗和是否发生术后并发症这两个因素是首次行腰椎管减压内固定术的患者功能预后的独立影响因素。采取骨科康复一体化模式、不伴发术后并发症的患者获得更良好的腰椎功能恢复。

A study on the prognostic factors of postoperative function recovery of lumbar degenerative diseases

Objective: To study the factors that influence functional recovery after single-level lumbar decompression surgery (LDS) in patients with lumbar degenerative diseases. Method: Totally 1152 cases of patients who underwent single-level LDS in 9 hospitals in Beijing were selected as subjects. The lumbar function outcome was assessed by the Japanese Orthopedic Association (JOA) lumbar spine scale before and 24 weeks after surgery, and was divided into excellent, good, fair, and poor according to functional status. 8 related factors were investigated including age, gender, Body Mass Index (BMI), preoperative function, surgery level, preoperative pain, rehabilitation in team approach, and postoperative complications. The factors influencing the functional recovery were analyzed by the method of ordered categorical logistic regression. Result: The postoperative lumbar spine JOA score was significantly better in the patients who underwent perioperative rehabilitation in team approach than those who underwent general orthopaedic treatment at 24 weeks after surgery (P<0.05)(OR=1.589,95% CI 0.193, 0.733]). The postoperative lumbar spine JOA score was significantly better in the patients without postoperative complications than those with postoperative complications at 24 weeks after surgery (P<0.05)(OR=2.300,95% CI 0.112, 1.555]). Conclusion: The study demonstrates that perioperative rehabilitation and whether postoperative complications occur are the factors affecting the functional prognosis. Patients who have undergone an integrated rehabilitation in team approach without postoperative complications have better recovery of lumbar function.