女性腰椎退变性疾病术后慢性腰痛的危险因素分析

The risk factors of chronic low back pain after surgery for lumbar degenerative disease in female patients

中文关键词:  慢性腰痛  危险因素  腰椎退变性疾病术后  围绝经期  围绝经期综合征

英文关键词:Chronic low back pain  Risk factor  Postoperative lumbar degenerative disease  Peri-menopausal period  Perimenopausal syndrome

中文摘要:

  【摘要】 目的：探讨女性腰椎退变性疾病术后慢性腰痛的危险因素。方法：以2014年1月~2016年9月在我院住院确诊为腰椎间盘突出症或退变性腰椎管狭窄症，行腰椎间盘髓核摘除或经后路腰椎椎间融合术（posterior lumbar interbody fusion，PLIF）或经椎间孔腰椎椎体间融合术（transforaminal lumbar interbody fusion，TLIF）的女性患者为研究对象。分别采用单因素Logistic回归分析、多因素Logistic回归分析及倾向得分匹配法（propensity score matching，PSM）对可能导致腰椎退变性疾病术后慢性腰痛的危险因素进行分析，寻找腰椎退变性疾病术后慢性腰痛的危险因素及独立危险因素。纳入研究的可能导致腰椎退变性疾病术后慢性腰痛的危险因素包括年龄、BMI、基础疾病（高血压、糖尿病和冠心病）、术前慢性腰痛、腰痛VAS评分、术前下肢疼痛时长、腿痛VAS评分、术前腰椎JOA评分、手术方式、手术节段数目、手术节段、术者、出血量、围绝经期、围绝经期综合征。结果：符合纳入标准的病例178例，成功随访147例，失访31例，随访率为82.58%，随访时间6~39个月（19.14±9.33个月）。年龄19~77岁（49.68±11.76岁）。其中围绝经期者63例（42.86%），合并围绝经期综合征者33例（22.45%）。术后慢性腰痛者53例（36.05%）。经单因素Logistic分析发现，腰椎退变性疾病术后慢性腰痛的危险因素有BMI、术前慢性腰痛、手术时间、手术出血量、围绝经期及围绝经期综合征（P<0.05）；经多因素Logistic分析发现，腰椎退变性疾病术后慢性腰痛独立危险因素有术前慢性腰痛、围绝经期及围绝经期综合征；经PSM分析发现，研究组（围绝经期组）与对照组（非围绝经期组）间慢性腰痛发生率的比较有统计学意差异（P<0.05）；合并围绝经期综合征组与未合并围绝经期综合征组间慢性腰痛发生率的比较无统计学差异（P>0.05）。结论：BMI、术前慢性腰痛、手术时间、手术出血量及围绝经期综合征是女性腰椎退变性疾病术后慢性腰痛的危险因素，围绝经期是女性腰椎退变性疾病术后慢性腰痛的独立危险因素。

英文摘要:

  【Abstract】 Objectives: To investigate whether peri-menopausal period is an independent risk factor for chronic low back pain after surgery for lumbar degenerative disease. Methods: From January 2014 to September 2016, female patients who diagnosed as lumbar disc herniation and degenerative lumbar canal stenosis underwent discectomy or posterior lumbar interbody fusion or transforaminal lumbar interbody fusion surgery were included in our study. Risk factors for chronic low back pain including age, body mass index(BMI), basic diseases, preoperative chronic low back pain, preoperative leg pain, VAS score of low back pain and leg pain, preoperative lumbar JOA score, operation method, number of surgery segment, surgery segment, operator, operation time, blood loss, peri-menopausal period and premenopausal syndrome were investigated in our study. All risk factors were analyzed with single factor logistic regression analysis, multiplicity logistic regression analysis and propensity score matching(PSM) respectively. Data were analyzed with SPSS 22.0. P<0.05 was found to be statistically significant. Results: Among 178 female patients, 147 cases were followed up successfully and 31 cases were lost, the follow-up rate was 82.58%. The follow-up time between 6 and 39 months, mean follow-up time was 19.14±9.33 months. The age ranged from 19 to 77 years old, the average age was 49.68±11.76 years. There were 63 cases with peri-menopausal period(42.86%) and 33 patients with perimenopausal period syndrome(22.45%). 53 cases underwent chronic low back pain(36.05%). The single factor logistic analysis showed that the risk factors associated with chronic low back pain were BMI, preoperative chronic low back pain, operation time, blood loss, peri-menopausal period and perimenopausal syndrome(P<0.05). The multivariate logistic analysis showed that independent risk factors associated with chronic low back pain of lumbar degenerative disease surgery were preoperative chronic low back pain, perimenopausal and menopausal syndrome. The PSM analysis showed that there was statistically significant(P<0.05) between the study group(group of peri-menopausal period) and control group(group of non peri-menopausal period) in the incidence of chronic low back pain. There was no statistically significant(P>0.05) between group A(patients with perimenopausal syndrome) and group B(patients without perimenopausal syndrome) in the incidence of chronic low back pain. Conclusions: For female patients, peri-menopausal period is an independent risk factor for chronic low back pain complicated by postoperative lumbar degenerative disease; BMI, preoperative chronic low back pain, operation time, intra-operative blood loss and perimenopausal syndrome are risk factors for chronic low back pain complicated by postoperative lumbar degenerative disease.