影响经皮椎间孔入路内镜下神经根减压治疗腰椎管狭窄症临床疗效的相关因素分析
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摘要
目的分析影响经皮椎间孔入路内镜下神经根减压治疗腰椎管狭窄症临床疗效的相关因素。方法回顾性分析2016年5月-2017年1月105例有完整随访记录的单节段腰椎管狭窄症患者,表现为单侧神经根症状,行经皮椎间孔入路内镜下神经根减压治疗,采用Oswestry功能障碍指数(ODI)评估手术疗效。对可能影响手术疗效的9个指标进行单因素分析,选取其中有统计学意义的指标进行Logistic回归分析。结果单因素分析显示:年龄、性别、跛行距离、病变节段分布、狭窄区域、椎间孔面积与手术疗效无明显相关(P>0.05);而病程、术前ODI评分及侧隐窝矢状径与手术疗效相关(P <0.05)。Logistic回归分析显示:病程和术前ODI评分为独立预后因素。结论病程、术前ODI评分及侧隐窝矢状径是影响手术疗效的相关因素,其中病程和术前ODI评分为独立预后因素。
Objective To investigate related factors for percutaneous endoscopic nerve root decompression via transforaminal approach on lumbar spinal stenosis. Methods From May 2016 to January 2017, 105 cases of single segment lumbar spinal stenosis who had completed follow-up data were involved. All the patients had unilateral lower extremity neurological symptoms, and underwent percutaneous endoscopic nerve root decompression via transforaminal approach. The operative effect was assessed according to Oswestry Disability Index(ODI). Firstly,single factor analysis was used in 9 clinical variables that might influence the surgical effect, including age, gender,duration of disease, claudication distance, preoperative ODI scores, segmental distribution, stenosis area, stenosis grade(the radius vector of lateral recesses and intervertebral foramen area). Then, Logistic regression analysis was performed to the indexes with statistical significance. Results Single factor analysis showed that age, gender,claudication distance, segmental distribution, stenosis area, intervertebral foramen area were not significantly correlated with operative effect(P > 0.05). While duration of disease, preoperative ODI scores and radius vector of lateral recesses were significantly correlated with operative effect(P < 0.05). Logistic regression analysis showed that duration of disease and preoperative ODI scores were the major factors influencing the operative effect. Conclusion Duration of disease, preoperative ODI scores and radius vector of lateral recesses were the related factors that affect the surgical effect. Of which, duration of disease and preoperative ODI scores were the major factors influencing the operative effect.
Objective To investigate related factors for percutaneous endoscopic nerve root decompression via transforaminal approach on lumbar spinal stenosis. Methods From May 2016 to January 2017, 105 cases of single segment lumbar spinal stenosis who had completed follow-up data were involved. All the patients had unilateral lower extremity neurological symptoms, and underwent percutaneous endoscopic nerve root decompression via transforaminal approach. The operative effect was assessed according to Oswestry Disability Index(ODI). Firstly,single factor analysis was used in 9 clinical variables that might influence the surgical effect, including age, gender,duration of disease, claudication distance, preoperative ODI scores, segmental distribution, stenosis area, stenosis grade(the radius vector of lateral recesses and intervertebral foramen area). Then, Logistic regression analysis was performed to the indexes with statistical significance. Results Single factor analysis showed that age, gender,claudication distance, segmental distribution, stenosis area, intervertebral foramen area were not significantly correlated with operative effect(P > 0.05). While duration of disease, preoperative ODI scores and radius vector of lateral recesses were significantly correlated with operative effect(P < 0.05). Logistic regression analysis showed that duration of disease and preoperative ODI scores were the major factors influencing the operative effect. Conclusion Duration of disease, preoperative ODI scores and radius vector of lateral recesses were the related factors that affect the surgical effect. Of which, duration of disease and preoperative ODI scores were the major factors influencing the operative effect.
引文
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[21]KUITTINEN P,SIPOLA P,LEINONEN V,et al.Preoperative MRI findings predict two-year postoperative clinical outcome in lumbar spinal stenosis[J].PLoS One,2014,9(9):e106404.
[2]陈远明,万健,黄中飞,等.改良椎间孔镜技术治疗腰椎间盘突出症的疗效分析[J].中国内镜杂志,2018,24(4):1-5.[2]CHEN Y M,WAN J,HUANG Z F,et al.Treatment of lumbar disc herniation with modified transforaminal endoscopic surgical system[J].China Journal of Endoscopy,2018,24(4):1-5.Chinese
[3]KOMP M,HAHN P,OZDEMIR S,et al.Operation of lumbar zygoapophyseal joint cysts using a full-endoscopic interlaminar and transforaminal approach:prospective 2-year results of 74patients[J].Surgical Innovation,2014,21(6):605-614.
[4]LEE C K,RAUSCHNING W,GLENN W.Lateral lumbar spinal canal stenosis:classification,pathologic anatomy and surgical decompression[J].Spine(Phila Pa 1976),1988,13(3):313-320.
[5]王玉,孔清泉,宋跃明.精准椎间孔成形减压术治疗腰椎侧隐窝狭窄症的近期疗效分析[J].中国修复重建外科杂志,2017,31(11):1334-1340.[5]WANG Y,KONG Q Q,SONG Y M.Short-term effectiveness of accurate decompression via foraminoplasty in treatment of lumbar lateral recess stenosis[J].Chinese Journal of Reparative and Reconstructive Surgery,2017,31(11):1334-1340.Chinese
[6]黎江芽.腰盘黄间隙狭窄的原因及意义(附83例CT平扫与CT脊髓造影对照)[J].中华放射学杂志,2000,34(4):268-270.[6]LI J Y.Causes and clinical significance of intervertibral disk flavum ligamentum space in lumbar stenosis(a comparative study of CTnon-contrast and CT-myelography of 83 cases)[J].Chin J Radiol,2000,34(4):268-270.Chinese
[7]FOKTER S K,YERBY S A.Patient-based outcomes for the operative treatment of degenerative lumbar spinal stenosis[J].Eur Spine J,2006,15(11):1661-1669.
[8]JO D J,JUN J K,KIM K T,et al.Lumbar Interbody fusion outcomes in degenerative lumbar disease:comparison of results between patients over and under 65 years of age[J].Journal of Korean Neurosurgical Society,2010,48(5):412-418.
[9]THORNES E,IKONOMOU N,GROTLE M.Prognosis of surgical treatment for degenerative lumbar spinal stenosis:a prospective cohort study of clinical outcomes and health-related quality of life across gender and age groups[J].The Open Orthopaedics Journal,2011,5:372-378.
[10]KEOROCHANA G,LAOHACHAROENSOMBAT W,WAJANAVISIT W,et al.Functional outcome after decompression and instrumented arthrodesis in degenerative lumbar spinal stenosis:factors influencing unsuccessful outcome change[J].JMed Assoc Thai,2011,94(12):1487-1494.
[11]YAMASHITA K,OHZONO K,HIROSHIMA K.Five-year outcomes of surgical treatment for degenerative lumbar spinal stenosis:a prospective observational study of symptom severity at standard intervals after surgery[J].Spine(Phila Pa 1976),2006,31(13):1484-1490.
[12]BOURAS T,STRANJALIS G,LOUFARDAKI M,et al.Predictors of long-term outcome in an elderly group after laminectomy for lumbar stenosis[J].J Neurosurg Spine,2010,13(3):329-334.
[13]NG L C,TAFAZAL S,SELL P.The effect of duration of symptoms on standard outcome measures in the surgical treatment of spinal stenosis[J].Eur Spine J,2007,16(2):199-206.
[14]SIGMUNDSSON F G,KANG X P,J?NSSON B,et al.Prognostic factors in lumbar spinal stenosis surgery:A prospective study of imaging-and patient-related factors in 109 patients who were operated on by decompression[J].Acta Orthopaedica,2012,83(5):536-542.
[15]RADCLIFF K,RIHN J,HILIBRAND A,et al.Does the duration of symptoms in patients with spinal stenosis and degenerative spondylolisthesis affect outcomes:analysis of the spine outcomes research trial[J].Spine(Phila Pa 1976),2011,36(25):2197-2210.
[16]KHAN M B,BASHIR M U,KUMAR R,et al.Enduring improvement in Oswestry Disability Index outcomes following lumbar microscopic interlaminar decompression:an appraisal of prospectively collected patient outcomes[J].J Craniovertebr Junction Spine,2015,6(4):195-199.
[17]VITAL J M,LAVIGNOLLE B,GRENIER N,et al.Anatomy of the lumbar radicular canal[J].Anat Clin,1983,5(3):141-151.
[18]LASSALE B,MORVAN G,GOTTIN M.Anatomy and radiological anatomy of the lumbar radicular canals[J].Anat Clin,1984,6(3):195-201.
[19]SPIVAK J M.Degenerative lumber spinal stenosis[J].J Bone Joint Surg(Am),1998,80(7):1053-1066.
[20]白一冰,李嵩鹏,王力文,等.改良TESSYS技术治疗腰椎神经根管狭窄症[J].颈腰痛杂志,2015,36(1):16-19.[20]BAI Y B,LI S P,WANG L W,et al.The modified TESSYStechnique for the treatment of lumbar nerve root canal stenosis[J].The Journal of Cervicodynia and Lumbodynia,2015,36(1):16-19.Chinese
[21]KUITTINEN P,SIPOLA P,LEINONEN V,et al.Preoperative MRI findings predict two-year postoperative clinical outcome in lumbar spinal stenosis[J].PLoS One,2014,9(9):e106404.