单侧双通道内镜手术治疗腰椎管狭窄症后残留腰痛的危险因素分析

Analysis of risk factors for residual back pain after unilateral dual channel endoscopic surgery for lumbar spinal stenosis

摘要:

目的:探讨单侧双通道内镜治疗腰椎管狭窄症术后残留腰痛的危险因素,为临床术前风险评估及干预提供依据。方法:回顾性分析2022年1月至2023年12月161例接受UBE手术的腰椎间盘突出症患者资料,收集临床及影像学参数,通过单变量及多变量逻辑回归分析术后2年残留腰痛(疼痛评分≥4分)的独立危险因素。结果:术后残留腰痛发生率为26.1%(42/161)。多因素回归显示,术前重度腰痛、腰椎滑脱(Meyerding I级)及Modic III型改变(终板硬化)是独立危险因素(P<0.05)。结论:UBE术后残留腰痛与术前重度疼痛、腰椎滑脱及终板硬化密切相关。建议术前完善影像学评估,术中优化减压策略以减少关节突切除,术后强化多模式镇痛及稳定性训练,以改善患者预后。

Abstract:

Objective: To explore the risk factors of lumbar disc herniation and provide a basis for clinical preoperative risk assessment and intervention. Methods: Data on 161 patients with UBE surgery from January 2022 to 12-2023, collected clinical and radiographic parameters and analyzed independent risk factors for residual low back pain (pain score 4 points after 2 years) by univariate and multivariate logistic regression. Results: The incidence of postoperative residual low back pain was 26.1% (42/161). Multivariate regression showed that preoperative severe LBP, lumbar spondylolisthesis (grade Meyerding I) and type Modic III change (endplate sclerosis) were independent risk factors (P<0.05). Conclusion: The residual LBP after UBE is closely related to severe preoperative pain, lumbar spondylolisthesis and endplate sclerosis. It is recommended to improve preoperative radiographic evaluation, optimize intraoperative decompression strategy to reduce joint process resection, and strengthen postoperative multimodal analgesia and stability training to improve patient prognosis.