腰椎间盘突出症与腰椎间盘突出症合并阻塞性睡眠呼吸暂停患者的对比研究

Comparative study of patients with lumbar disc herniation and patients with lumbar disc herniationcomplicated and obstructive sleep apnea

摘要:

目的 探究腰椎间盘突出症（LDH）与阻塞性睡眠呼吸暂停（OSA）之间的关联，为LDH的临床诊治策略及治疗方案提供参考依据。方法 选取2018年1月—2020年3月中国医科大学附属第一医院骨科行外科手术治疗的485例LDH患者，按是否合并OSA进行分组研究。结果 485例LDH患者中合并OSA的307例，发生率为63.3%。LDH合并OSA组主观症状、临床症状、日常活动受限程度日本骨科协会（JOA）腰痛评分低于单纯LDH组（P < 0.05）；两组膀胱功能JOA评分比较，差异无统计学意义（P > 0.05）；LDH合并OSA组视觉模拟评分法（VAS）评分高于单纯LDH组（P < 0.05）。Pfirrmann 5级评分法中4、5级例数构成比LDH合并OSA组较单纯LDH组高（P < 0.05）。两组患者的硬膜撕裂率、神经受损率、血肿率、切口感染率等并发症发生率比较，差异无统计学意义（P >0.05）。单纯LDH组与LDH合并OSA组术后3、6、12和24个月静息状态下JOA和VAS评分比较，采用重复测量设计的方差分析，结果 ①不同时间点的JOA和VAS评分有差异（F =19.264和24.316，均P =0.000）；②单纯LDH组和LDH合并OSA组静息状态下JOA和VAS评分有差异（F =105.411和93.521，均P =0.000）；③单纯LDH组和LDH合并OSA组JOA和VAS评分变化趋势有差异（F =24.256和27.354，均P =0.000）。术后6、12、24个月单纯LDH组分别有7、27、32例复发，而LDH合并OSA组分别有7、81、117例复发。结论 LDH患者中OSA有较高的发生率，LDH合并OSA患者腰腿部疼痛、椎间盘退变的程度较单纯LDH患者严重，复发率较单纯LDH患者高，OSA是LDH的促进因素。

Abstract:

Objective To explore the relationship between lumbar disc herniation (LDH) and obstructive sleep apnea (OSA), and to provide reference for the clinical diagnosis and treatment strategy and treatment plan of LDH.Methods The data of LDH patients who underwent surgical treatment in the Department of Orthopedics of the First Hospital of China Medical University from January 2018 to March 2020 were sorted, and the study was carried out according to whether they had OSA or not.Results A total of 485 LDH patients were included in this study, of which 307 were combined with OSA. The incidence of LDH combined with OSA was 63.3%. The subjective symptoms, clinical symptoms and low back pain score of Japanese Orthopaedic Association Score (JOA) in LDH group combined with OSA were lower than those in LDH group (P < 0.05). There was no significant difference in JOA bladder function between the two groups (P > 0.05). Visual Analogue Score (VAS) of LDH combined with OSA group was higher than that of LDH group (P < 0.05). The proportion of grade 4 and 5 cases in Pfirrmann grade 5 scoring method was higher in LDH combined with OSA group than in LDH group (P < 0.05). There was no significant difference in the incidence of complications such as dural tear rate, nerve damage rate, hematoma rate and incision infection rate between two groups (P >0.05). JOA and VAS scores were compared between LDH group and LDH group combined with OSA group at resting state 3, 6, 12 and 24 months after surgery, which showed that there were differences in JOA and VAS scores at different time points (P < 0.05) and among two groups (P < 0.05), and that the change trends of JOA and VAS scores between two groups (P < 0.05). After 6, 12 and 24 months, there were 7, 27 and 32 cases of recurrence in LDH group, and 7, 81 and 117 cases of recurrence in the LDH combined with OSA group, respectively.Conclusion LDH patients have a higher incidence of OSA. LDH patients with OSA have more severe lumbar and leg pain and intervertebral disc degeneration than patients with LDH alone, and the recurrence rate is higher than patients with LDH alone. OSA is a promoting factor for LDH.