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殷杰,乔林,封慧玲,徐军鹏,王彦鹏.经椎间孔脊柱内窥镜系统治疗腰椎椎管狭窄症术后早期效果不良的影响因素[J].脊柱外科杂志,2024,22(3):182-188.
经椎间孔脊柱内窥镜系统治疗腰椎椎管狭窄症术后早期效果不良的影响因素     点此下载全文 (Fulltext)
殷杰1  乔林1  封慧玲1  徐军鹏1  王彦鹏2*
1. 中国人民解放军联勤保障部队第987医院骨科, 宝鸡 721004;
2. 陕西省中医医院骨科, 西安 710004
基金项目:
DOI:10.3969/j.issn.1672-2957.2024.03.007
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摘要:
      目的 分析采用经椎间孔脊柱内窥镜系统(TESSYS)治疗腰椎管狭窄症(LSS)术后早期效果不良的因素。 方法 回顾性分析中国人民解放军联勤保障部队第987医院2020年6月—2022年5月收治的136例LSS患者资料,根据改良MacNab标准分为疗效不良组(疗效为差,n=38)和疗效良好组(疗效为优、良、可,n=98)。收集2组患者一般资料、基础疾病、疾病相关因素和手术相关因素等资料,并进行单因素和多因素分析,基于差异性分析构建预测术后早期效果不良的列线图模型,并进行模型验证。 结果 体质量指数(BMI)> 23.10/(kg·m-2)、病程> 4年、有糖尿病史、重度LSS、术前合并终板炎、手术时间> 68 min、双节段手术、术后过度活动评分> 3分、手术前后椎管横截面积差< 0.15 cm2、手术前后硬膜囊横截面积差< 0.25 cm2、手术前后椎间孔矢状径差< 1.15 mm、手术前后侧隐窝宽度差< 1.15 mm为术后早期疗效不良的危险因素。多重共线性诊断分析结果发现,各因素之间无共线性关系。基于多因素分析结果构建列线图预测模型,BMI偏大(31分)、有糖尿病史(36分)、手术时间长(55分)、病程长(82分)、术后过度活动评分高(64分)、术前合并终板炎(46分)、双节段手术(68分)、重度LSS(58分)、手术前后椎管横截面积差小(83分)、手术前后硬膜囊横截面积差小(29分)、手术前后椎间孔矢状径差小(93分)、手术前后侧隐窝宽度差小(56分),总分701分,对应术后早期疗效不良概率为73.97%。 结论 TESSYS治疗LSS术后早期效果不良的影响因素较多,为降低术后复发及再手术的风险,应对患者术前临床资料以及术中和术后的相关指标进行相应把控。
关键词:腰椎  椎管狭窄  内窥镜检查  外科手术,微创  术后并发症
Factors influencing early postoperative adverse effects of transforaminal endoscopic spinal system for treatment of lumbar spinal stenosis    Fulltext
Yin Jie1  Qiao Lin1  Feng Huiling1  Xu Junpeng1  Wang Yanpeng2*
1. Department of Orthopaedics, No. 987 Hospital of Joint Logistic Support Force of Chinese PLA, Baoji 721004, Shaanxi, China;
2. Department of Orthopaedics, Shaanxi Hospital of Traditional Chinese Medicine, Xi'an 710004, Shaanxi, China
Fund Project:
Abstract:
      Objective To analyze the factors influencing early postoperative adverse effects of transforaminal endoscopic spinal system(TESSYS) for treatment of lumbar spinal stenosis(LSS).Methods From June 2020 to May 2022,data of 136 patients with LSS admitted to No. 987 Hospital of the Chinese People's Liberation Army Joint Logistics Support Force were retrospectively analyzed. According to the modified MacNab criteria,they were divided into poor efficacy group(poor efficacy,n=38) and good efficacy group(excellent,good and fair efficacy,n=98). General data,underlying diseases,disease-related factors and surgery-related factors of the 2 groups were collected,and univariate and multivariate analyses were performed. Based on the difference analysis,a nomogram model for predicting early postoperative adverse effects was constructed and verified. Results Body mass index(BMI)> 23.10/(kg·m-2),course of disease > 4 years,history of diabetes,severe LSS,preoperative endplate inflammation,operation time > 68 min,double-level surgery,postoperative hyperactivity score > 3,difference in cross-sectional area of spinal canal before and after surgery < 0.15 cm2,difference in cross-sectional area of dural sac before and after surgery < 0.25 cm2,difference in sagittal diameter of intervertebral foramen before and after surgery < 1.15 mm,and difference in lateral recess width before and after surgery < 1.15 mm were risk factors for early postoperative adverse effects. The results of multicollinearity diagnosis showed that there was no collinear relationship between the factors. The nomogram prediction model was constructed based on the results of multi-factor analysis:high BMI(31 points),with history of diabetes(36 points),long operation time(55 points),long course of disease(82 points),high postoperative hyperactivity score(64 points),preoperative complication of endplate inflammation(46 points),double-level surgery(68 points),severe LSS(58 points),small difference in cross-sectional area of spinal canal before and after surgery(83 points),small difference in cross-sectional area of dural sac before and after surgery(29 points),small difference in sagittal diameter of intervertebral foramen before and after surgery(93 points),and small difference in width of lateral recess before and after surgery(56 points),with a total score of 701 points. The corresponding probability of early postoperative adverse effect was 73.97%. Conclusions There are many factors causing the early postoperative adverse effect of TESSYS in treatment of LSS. In order to reduce the risk of postoperative recurrence and reoperation,preoperative clinical data and relevant indicators during and after surgery should be controlled.
Keywords:Lumbar vertebrae  Spinal stenosis  Endoscopy  Surgical procedures,minimally invasive  Postoperative complications
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