一项比较肥胖和非肥胖腰椎间盘突出症患者手术治疗结果的研究：一项对瑞典国家质量登记处 9979 例患者的研究。
A study comparing outcomes between obese and nonobese patients with lumbar disc herniation undergoing surgery: a study of the Swedish National Quality Registry of 9979 patients.
机构信息
Departments Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Inga Marie Nilssons gata 22, plan 4, 205 02, Malmö, Sweden.
Department of Orthopedics, Halland Hospital, Varberg, Sweden.
出版信息
BMC Musculoskelet Disord. 2022 Oct 22;23(1):931. doi: 10.1186/s12891-022-05884-8.
BACKGROUND
This study aimed to evaluate whether an increasing grade of obesity is associated with inferior outcomes after lumbar disc herniation (LDH) surgery.
METHODS
We retrieved data from the Swedish register for spine surgery regarding patients aged 20-64 who underwent LDH surgery from 2006-2016 and had preoperative and one-year postoperative data. A total of 4156 patients were normal weight, 4063 were overweight, 1384 had class I obesity, 317 had class II obesity and 59 had class III obesity ("morbid obesity"). Data included patient satisfaction, improvement in leg pain (assessed using the National Rating Scale; NRS; rating 0-10), disability (assessed using the Oswestry Disability Index; ODI; rating 0-100) and complications.
RESULTS
At one year postsurgery, 80% of normal-weight patients, 77% of overweight patients and 74% of obese patients (class I-III evaluated together) were satisfied (p < 0.001) [75%, 71%, 75% in obesity classes I, II, and III, respectively (p = 0.43)]. On average, all groups improved by more than the minimal clinically important difference (MCID) in both NRS leg pain (> 3.5) and ODI (> 20). NRS leg pain improved by 4.8 in normal weight patients (95% CI 4.7-4.9), by 4.5 in overweight patients (4.5-4.6) and by 4.3 in obese patients (4.2-4.4) (p < 0.001) [4.4 (4.3-4.6), 3.8 (3.5-4.1) and 4.6 (3.9-5.3) in obesity classes I, II, and III, respectively (p < 0.001)]. The ODI improved by 30 in normal weight patients (30-31), by 29 in overweight patients (28-29) and by 26 in obese patients (25-27) (p < 0.001) [29 (28-29), 25 (22-27) and 27 (22-32) in obesity classes I, II, and III, respectively (p < 0.01)]. A total of 3.0% of normal-weight patients, 3.9% of overweight patients and 3.9% of obese patients suffered complications (p = 0.047) [3.8%, 4.4%, 3.5% in obesity classes I, II, and III, respectively (p = 0.90)].
CONCLUSIONS
LDH surgery is also generally associated with favourable outcomes and few complications in patients with morbid obesity.
背景
本研究旨在评估腰椎间盘突出症 (LDH) 手术后肥胖程度的增加是否与预后不良相关。
方法
我们从瑞典脊柱外科登记处检索了 2006 年至 2016 年间接受 LDH 手术且术前和术后一年均有数据的 20-64 岁患者的数据。4156 名患者为正常体重，4063 名患者超重，1384 名患者为 I 级肥胖，317 名患者为 II 级肥胖，59 名患者为 III 级肥胖（“病态肥胖”）。数据包括患者满意度、腿部疼痛改善（使用国家评分量表[NRS]评估；评分 0-10）、残疾（使用 Oswestry 残疾指数[ODI]评估；评分 0-100）和并发症。
结果
术后一年，80%的正常体重患者、77%的超重患者和 74%的肥胖患者（I-III 级肥胖患者综合评估）满意（p<0.001）[肥胖 I、II 和 III 级患者分别为 75%、71%和 75%（p=0.43）]。所有组的 NRS 腿部疼痛（>3.5）和 ODI（>20）评分均改善超过了最小临床重要差异（MCID）。正常体重患者的 NRS 腿部疼痛平均改善 4.8（95%CI 4.7-4.9），超重患者改善 4.5（4.5-4.6），肥胖患者改善 4.3（4.2-4.4）（p<0.001）[肥胖 I、II 和 III 级患者分别为 4.4（4.3-4.6）、3.8（3.5-4.1）和 4.6（3.9-5.3）（p<0.001）]。NRS 腿部疼痛评分改善 30 分，正常体重患者（30-31），超重患者（29-29）和肥胖患者（26-27）（p<0.001）[肥胖 I、II 和 III 级患者分别为 29（28-29）、25（22-27）和 27（22-32）（p<0.01）]。正常体重患者有 3.0%、超重患者有 3.9%、肥胖患者有 3.9%（p=0.047）出现并发症[肥胖 I、II 和 III 级患者分别为 3.8%、4.4%和 3.5%（p=0.90）]。
结论
LDH 手术后，病态肥胖患者的预后通常也较好，并发症也较少。
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