Suzuki Akinobu, Matsumura Akira, Konishi Sadahiko, Terai Hidetomi, Tsujio Tadao, Dozono Sho, Nakamura Hiroaki
Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
J Spinal Disord Tech. 2011 Feb;24(1):1-5. doi: 10.1097/BSD.0b013e3181c5be1d.
Retrospective study of multivariable analysis for the risk factors of motor deficit associated with lumbar disc herniation (LDH).
To identify the risk factors for motor deficit and delayed recovery after surgery in patients with LDH.
LDH can cause motor deficit as well as pain and sensory disturbance. Even though motor deficit can lead to disabilities and affect treatment plans, few studies have described motor deficit and its risk factors in LDH patients.
Seventy-six consecutive patients who underwent microsurgical or microendoscopic discectomy for LDH at the L4/5 level were retrospectively reviewed. Motor deficit was defined as tibialis anterior muscle strength of lower than grade 4 by the manual muscle test, and delayed recovery was defined as cases requiring longer than 3 months to achieve complete recovery. The possible risk factors including sex, age, symptom duration, preoperative radiographic parameters, and type of herniation were evaluated by multivariate logistic regression analysis.
Forty-three patients (56.6%) suffered from motor deficit before surgery. Forty cases (93%) completely recovered within a mean duration of 4 months. Multivariate logistic regression analysis revealed that noncontained-type (P=0.012, odds ratio=13.7) and migrated herniated nucleus pulposus (P=0.033, odds ratio=9.8) were important risk factors for motor deficit. Furthermore, severe motor deficit (preoperative manual muscle test≤3; P=0.019, odds ratio=19.6) and noncontained type (P=0.049, odds ratio=5.17) were identified as important risk factors for delayed recovery.
Noncontained-type or migrated herniated nucleus pulposus seem to be the most important risk factors for motor deficit in LDH, whereas severe motor deficit and noncontained type seem to be associated with delayed recovery. The treatment options for patients with these factors at first visit should be carefully chosen during the follow-up period.
对腰椎间盘突出症（LDH）相关运动功能障碍危险因素进行多变量分析的回顾性研究。
确定LDH患者术后运动功能障碍及恢复延迟的危险因素。
LDH可导致运动功能障碍以及疼痛和感觉障碍。尽管运动功能障碍会导致残疾并影响治疗方案，但很少有研究描述LDH患者的运动功能障碍及其危险因素。
回顾性分析76例在L4/5节段接受显微手术或显微内镜下椎间盘切除术治疗LDH的连续患者。运动功能障碍定义为通过徒手肌力测试胫前肌肌力低于4级，恢复延迟定义为需要超过3个月才能完全恢复的病例。通过多变量逻辑回归分析评估包括性别、年龄、症状持续时间、术前影像学参数和突出类型等可能的危险因素。
43例患者（56.6%）术前存在运动功能障碍。40例（93%）在平均4个月内完全恢复。多变量逻辑回归分析显示，游离型（P=0.012，比值比=13.7）和脱出型髓核（P=0.033，比值比=9.8）是运动功能障碍的重要危险因素。此外，严重运动功能障碍（术前徒手肌力测试≤3；P=0.019，比值比=19.6）和游离型（P=0.049，比值比=5.17）被确定为恢复延迟的重要危险因素。
游离型或脱出型髓核似乎是LDH患者运动功能障碍的最重要危险因素，而严重运动功能障碍和游离型似乎与恢复延迟有关。对于初次就诊时有这些因素的患者，在随访期间应谨慎选择治疗方案。
