腰椎融合術後功能性表現之臨床預測模型

Clinical Prediction Model for Functional Performance Following Lumbar Fusion Surgery

黃薇瑾(Wei-Jin Wong)

指導教授 ： 徐瑋勵

國立臺灣大學/醫學院/物理治療學研究所/碩士(2019年)

https://doi.org/10.6342/NTU201903051

摘要

背景： 退化性腰椎病變患者常伴隨疼痛、日常功能受限及平衡能力受損。過去研究發現，患者於腰椎融合術前的個人特性與術後的日常功能進步程度有關。然而，患者於腰椎融合術前的平衡表現對術後的功能性表現進步程度的影響仍未知。
研究目的：探討退化性腰椎病變患者於腰椎融合術前的平衡表現與術後12個月的功能性表現進步程度之間的關係，並建立一腰椎融合術後功能性活動表現之預測模型。
研究設計：前瞻性世代研究
研究方法：本研究在2014至2019年於一醫學中心招募了100位退化性腰椎病變患者。此研究收集了所有受試者術前與術後的基本身體資料、問卷調查(疼痛視覺類比量表 Visual Analog Scale、歐氏失能量表 Oswestry Disability Index) 及平衡表現。平衡測試為在受試者開眼和閉眼的情況下，於力板上雙腳與肩同寬站立和雙足併攏站立維持35秒，並記錄站立時的足底壓力中心之位移。本研究使用邏輯斯迴歸分析，功能性表現的進步為依變數，術前平衡表現與患者特性為預測因子。術後的歐氏失能量表分數相比術前的分數下降超過12.8分定義為功能性表現的進步。
研究結果：本研究100名患者中，有77名患者的功能性表現於術後12個月進步。於單變項迴歸分析中，術前平衡表現中的雙腳與肩同寬站立與閉眼測試的結果較差（勝算比[Odds ratio, OR] = 0.92, P = 0.012）與術後功能性表現的進步較少相關。於多變項迴歸分析中，術後有較差的功能性表現進步之預測因子為：術前平衡表現較差、術前歐氏失能量表分數較低、年齡較大、身高體重指數較高和症狀持續時間較長，且此模型的曲線下方的面積為0.90。性別、身高、體重、術前疼痛程度及在開眼雙腳與肩同寬和張眼/閉眼雙腳合併的平衡表現與術後功能性表現的進步無關。
結論：退化性腰椎病變患者於腰椎融合術前，若有較差的平衡表現，可預測術後會有較差的功能性表現改變。本研究建立了一可預測腰椎融合術後功能性表現進步之預測模型，且可提供臨床手術決策與患者對於手術療效的期望之重要指標。

關鍵字

平衡表現 ； 足底壓力中心 ； 退化性腰椎病變 ； 腰椎融合術 ； 功能性測試量表 ； 病人報告結果

並列摘要

Background: Degenerative lumbar spine disease (DLSD) is often accompanied by pain, functional impairment, and balance impairment. Preoperative patient characteristics have been associated with functional improvement after lumbar fusion. However, the effect of preoperative balance performance on functional improvement after lumbar surgery was unclear.
Objective: To determine the association between the preoperative balance performance of patients with DLSD and the functional improvement 12 months postoperatively and to develop a prediction tool for functional improvement.
Design: Prospective cohort study
Methods: Patients with DLSD (n = 100) were prospectively enrolled between 2014 and 2019 in a medical center. Balance performance assessment and patient-reported outcomes were completed by all patients before lumbar fusion surgery and 12 months postoperatively. Each participant performed 4 standing tasks: natural stance with eyes open (EO) and eyes closed (EC), and Romberg stance with eyes open (RSEO) and eyes closed (RSEC). Logistic regression analysis was conducted with functional improvement as the outcome, and with preoperative balance performance and patient characteristics as predictors. Functional improvement was defined as a reduction in the Oswestry Disability Index (ODI) score of 12.8 or more between before and after surgery.
Results: Seventy-seven patients showed improvement in functional performance 12 months postoperatively. On univariate analysis, poor preoperative balance performance in natural stance under eyes closed (odds ratio [OR] = 0.92, P = 0.012) was associated with less optimal functional improvement postoperatively. On multivariate analysis, predictors of less optimal outcome included poor preoperative balance performance, low preoperative ODI score, old age, high body mass index, and long symptom duration, with an area under curve of 0.90 for the model. Sex, height, weight, preoperative pain level, and preoperative balance performance under EO, RSEO, and RSEC showed no association with functional improvement postoperatively.
Conclusion: Poor preoperative balance performance may predict a lower likelihood of functional improvement after lumbar fusion for DLSD. This study developed a prediction model for postoperative functional improvement, which may provide useful information for surgical decision-making and perioperative expectations.

並列關鍵字

Balance performance ； Center of pressure ； Degenerative lumbar spine disease ； Lumbar fusion surgery ； Oswestry Disability Index ； Patient-reported outcome

參考文獻

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