影响腰椎滑脱症手术疗效相关因素分析

发布时间：2018-04-04 20:47

  本文选题：腰椎滑脱症　切入点：术后疗效　出处：《宁夏医科大学》2015年硕士论文

【摘要】：目的采用Logistic回归分析筛选出可能影响腰椎滑脱症手术疗效的危险因素,为今后临床上治疗腰椎滑脱症选择手术时机和手术方案提供参考依据和指导,同时为进一步研究影响腰椎滑脱症远期疗效的相关因素奠定基础。方法采用回顾-前瞻性队列研究方法,以2007年-2012年六年期间因腰椎滑脱症在宁夏医科大学总医院脊柱骨科行手术治疗的患者为研究对象,通过医院病案系统,收集患者的术前资料,通过门诊及电话随访收集患者的术后情况,按照统一的调查表对患者进行随访、调查。调查的内容包括:性别、年龄、体重指数、滑脱节段、滑脱的类型、滑脱程度、病程的长短、术前JOA评分、术前椎间高度比值、手术方式、减压范围、融合方式、是否使用Cage、术后即刻复位率、末次随访复位丢失率、末次随访椎间高度比值,将这些可能影响临床疗效的相关因素作为自变量。通过末次随访及术前JOA评分,计算好转率,并以此作为临床疗效的判断指标,将其进行二分类变量处理,分为疗效优良组(好转率50%)及疗效欠佳组(好转率≤50%)。通过t检验(计量资料)或χ2检验(计数资料)对所有自变量进行单因素分析,以P0.05为水准,筛选出可能影响手术疗效的危险因素。然后将筛选出的自变量进行非条件Logistic回归分析。结果最终获得随访且数据收集完整的病例126份,其中男85例,女41例,平均年龄51.15±9.54(26-76)岁,平均随访时间46(24-86)月。术后疗效:优:20例,良:79例,中:23例,差:4例,优良率为78.6%。单因素分析结果显示:体重指数、术前JOA评分、末次随访椎间高度比值、术后滑脱复位率对腰椎滑脱症手术疗效的影响有统计学意义(PO.05);再次进行二分类Logistic多因素回归分析,其结果显示:术前JOA评分对手术疗效的影响有统计学意义(PO.05)。结论1、性别、年龄、体重指数、滑脱节段、滑脱的类型、滑脱程度、病程的长短、术前椎间高度比值、手术方式、减压范围、植骨方式、是否使用Cage、术后滑脱复位率、末次随访滑脱复位率丢失率、末次随访椎间高度比值对腰椎滑脱症手术疗效的影响没有统计学意义。2、患者术前JOA评分对手术疗效的影响是有统计学差异的。本研究探讨发现,术前JOA评分是术后疗效的保护性因素,术前JOA评分越高,其术后疗效相对越好。3、手术方式的选择要根据患者症状、体征及影像学检查做到个性化处理,在减压、复位、固定融合等几个步骤要略有侧重。
[Abstract]:Objective to screen out the risk factors of lumbar spondylolisthesis by Logistic regression analysis, and to provide reference and guidance for the choice of surgical timing and surgical scheme for lumbar spondylolisthesis in the future.It also lays a foundation for further study of the related factors affecting the long-term outcome of lumbar spondylolisthesis.Methods retrospective prospective cohort study was performed on patients with lumbar spondylolisthesis who underwent surgical treatment in the Department of Spinal Orthopaedics, General Hospital of Ningxia Medical University, from 2007 to 2012.The preoperative data were collected and the postoperative data were collected through outpatient and telephone follow-up. The patients were followed-up and investigated according to the unified questionnaire.The contents of the survey included gender, age, body mass index, slip segment, type of slippage, degree of slippage, duration of disease, preoperative JOA score, preoperative intervertebral height ratio, surgical procedure, range of decompression, fusion.Whether Cagewas used, the rate of immediate reduction after operation, the rate of lost reduction at the last follow-up, and the ratio of intervertebral height at the last follow-up were taken as independent variables.According to the last follow-up and preoperative JOA score, the improvement rate was calculated and used as an index to judge the clinical curative effect. The patients were divided into two groups: good effect group (improvement rate 50) and poor effect group (improvement rate 鈮，

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