Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050051, China.
Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, 139 Ziqiang Road, Shijiazhuang 050051, China.
Pain Res Manag. 2021 Dec 20;2021:3971396. doi: 10.1155/2021/3971396. eCollection 2021.
To explore the influencing factors of satisfaction with postoperative treatment in patients diagnosed with thoracic ossification of the ligamentum flavum during different follow-up periods.
This was a retrospective study of 57 patients who were diagnosed with thoracic ossification of ligamentum flavum (TOLF) and treated with laminectomy in the Spine Surgery Department of the Third Hospital of Hebei Medical University from January 2010 to January 2017. The Patient Satisfaction Index (PSI) was collected at discharge and at 6-month, 1-year, and the last follow-up. According to the evaluation results, the patients could be divided into a satisfied group and a dissatisfied group. The patient's Japanese Orthopaedic Association (JOA) score improvement rate was evaluated at the last follow-up. Possible influencing factors of the two groups of patients were compared and the related influencing factors of satisfaction with postoperative treatment in patients during different follow-up periods were summarized.
At the time of discharge, the dissatisfied and satisfied groups had significant differences in variables of diabetes mellitus, duration of preoperative symptoms, urination disorder, intramedullary signal change on MRI, dural ossification, residual rate of cross-sectional spinal canal area on CT, shape on the sagittal MRI, hospital stay, hospitalization expenses, postoperative pain in LE VAS, delayed wound healing, postoperative depression, and intercostal pain ( < 0.05). There were also significant differences in urination disorder, postoperative pain according to the LE VAS, JOA score, and postoperative depression during the 6-month follow-up ( < 0.05). There were no significant differences in other variables between the two groups ( > 0.05). One year after the operation, there were significant differences between the dissatisfied group and the satisfied group in urination disorder, JOA score, and symptom recurrence ( < 0.05). There were also significant differences in the JOA score and symptom recurrence at the final follow-up ( < 0.05). For further analysis, the duration of preoperative symptoms in the satisfied group was less than 24 months and the duration of preoperative symptoms in the dissatisfied group was more than 24 months. The JOA scores of patients in the satisfied group and the dissatisfied group increased gradually with the improvement of neurological function in different follow-up periods, but, at the last follow-up, the JOA scores of patients in the satisfied group were significantly higher than those in the dissatisfied group.
In conclusion, for thoracic ossification of ligamentum flavum patients who received laminectomy, dissatisfaction with the early and medium-term postoperative results may be related to diabetes, the duration of preoperative symptoms, hospitalization expenses, delayed wound healing, intercostal pain, and urination disorder, and dissatisfaction with the long-term postoperative results might be related to the low JOA score improvement rate and symptom recurrence.
探讨不同随访时间点胸椎管狭窄症（thoracic ossification of the ligamentum flavum，TOLF）患者术后治疗满意度的影响因素。
回顾性分析 2010 年 1 月至 2017 年 1 月河北医科大学第三医院脊柱外科收治的 57 例行椎板切除术治疗的 TOLF 患者的临床资料。收集患者出院时及术后 6 个月、1 年、末次随访时的患者满意度指数（Patient Satisfaction Index，PSI）。根据评分结果将患者分为满意组和不满意组，末次随访时评估患者日本骨科协会（Japanese Orthopaedic Association，JOA）评分改善率。比较两组患者的可能影响因素，并总结不同随访时间点患者术后治疗满意度的相关影响因素。
出院时，不满意组和满意组在糖尿病、术前症状持续时间、排尿障碍、MRI 椎管内脊髓信号改变、硬脊膜骨化、CT 椎管横截面积残余率、矢状位 MRI 形态、住院时间、住院费用、术后下肢视觉模拟评分法（visual analogue scale，VAS）疼痛、切口愈合延迟、术后抑郁、肋间痛方面差异有统计学意义（ < 0.05）；术后 6 个月时，两组在排尿障碍、术后下肢 VAS 疼痛、JOA 评分、术后抑郁方面差异有统计学意义（ < 0.05）；其余时间点两组患者上述各变量比较，差异均无统计学意义（ > 0.05）。术后 1 年时，不满意组和满意组在排尿障碍、JOA 评分、症状复发方面差异有统计学意义（ < 0.05）；末次随访时，两组在 JOA 评分、症状复发方面差异有统计学意义（ < 0.05）。进一步分析发现，满意组患者术前症状持续时间＜24 个月，不满意组患者术前症状持续时间＞24 个月。满意组和不满意组患者在不同随访时间点的 JOA 评分均逐渐升高，神经功能改善，但末次随访时满意组患者的 JOA 评分明显高于不满意组。
胸椎管狭窄症患者行椎板切除术后，早期及中期对术后结果不满意可能与糖尿病、术前症状持续时间、住院费用、切口愈合延迟、肋间痛、排尿障碍有关，而对长期术后结果不满意可能与 JOA 评分改善率低、症状复发有关。
