目的:鉴于男女之间独特的生理和社会特征,我们认为腰椎退变性椎间盘疾病手术有明显的危险因素,包括腰椎间盘突出症(LDH)和腰椎管狭窄症(LSS),在中老年人群中。然而,很少有研究关注中老年妇女。这项研究旨在确定这些风险因素,特别是在该人群中。
方法:在本病例对照研究中,研究组包括1202名年龄≥45岁的女性,他们接受了腰椎间盘退变性疾病的手术治疗(LDH,n=825;LSS,n=377),对照组包括1168名没有腰椎疾病的妇女,她们在同一时期访问了健康体检诊所。研究因素包括人口统计学(年龄,体重指数[BMI],吸烟,劳动强度,和遗传史),女性特定因素(更年期状态,交货数量,剖宫产,和简单的子宫切除术),手术史(腹部手术次数,髋关节手术,膝关节手术,和甲状腺切除术),和全身性疾病(高胆固醇血症,高甘油三酯血症,高低密度脂蛋白胆固醇血症,高血压,糖尿病,心血管疾病,和脑血管疾病)。采用多元二元logistic回归分析计算相关因素的比值比(OR)和95%可信区间(95%CI)。
结果:中老年妇女LDH手术治疗的危险因素包括BMI(OR=1.603),劳动强度(OR=1.189),遗传史(OR=2.212),交货数量(OR=1.736),单纯子宫切除术(OR=2.511),高甘油三酯血症(OR=1.932),高低密度脂蛋白胆固醇血症(OR=2.662)。对于LSS的手术治疗,危险因素为年龄(OR=1.889),BMI(OR=1.671),遗传史(OR=2.134),交货数量(OR=2.962),单纯子宫切除术(OR=1.968),膝关节手术(OR=2.527),高甘油三酯血症(OR=1.476),高低密度脂蛋白胆固醇血症(OR=2.413),和糖尿病(OR=1.643)。脑血管疾病是LDH手术的保护因素(OR=0.267)。
结论:BMI,遗传史,交货数量,单纯子宫切除术,高甘油三酯血症,高低密度脂蛋白胆固醇血症是中老年妇女手术治疗LDH和LSS的独立危险因素。发现两个差异:劳动强度是LDH患者的危险因素,膝关节手术和糖尿病是LSS患者的危险因素。
OBJECTIVE: Given the distinct physiological and societal traits between women and men, we propose that there are distinct risk factors for lumbar degenerative disc disease surgeries, including lumbar disc herniation (LDH) and lumbar spinal stenosis (LSS), in middle-aged and older populations. However, few studies have focused on middle-aged and older women. This study aims to identify these risk factors specifically in this population.
METHODS: In this
case-control study, the study group comprised 1202 women aged ≥ 45 years who underwent operative treatment of lumbar degenerative disc disease (LDH, n = 825; LSS, n = 377), and the control group comprised 1168 women without lumbar disease who visited a health examination clinic during the same period. The study factors included demographics (age, body mass index [BMI], smoking, labor intensity, and genetic history), female-specific factors (menopausal status, number of deliveries, cesarean section, and simple hysterectomy), surgical history (number of abdominal surgeries, hip joint surgery, knee joint surgery, and thyroidectomy), and systemic diseases (hypercholesterolemia, hypertriglyceridemia, hyper-low-density lipoprotein cholesterolemia, hypertension, diabetes, cardiovascular disease, and cerebrovascular disease). Multivariate binary logistic regression analysis was used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) of associated factors.
RESULTS: The risk factors for surgical treatment of LDH in middle-aged and older women included BMI (OR = 1.603), labor intensity (OR = 1.189), genetic history (OR = 2.212), number of deliveries (OR = 1.736), simple hysterectomy (OR = 2.511), hypertriglyceridemia (OR = 1.932), and hyper-low-density lipoprotein cholesterolemia (OR = 2.662). For surgical treatment of LSS, the risk factors were age (OR = 1.889), BMI (OR = 1.671), genetic history (OR = 2.134), number of deliveries (OR = 2.962), simple hysterectomy (OR = 1.968), knee joint surgery (OR = 2.527), hypertriglyceridemia (OR = 1.476), hyper-low-density lipoprotein cholesterolemia (OR = 2.413), and diabetes (OR = 1.643). Cerebrovascular disease was a protective factor against surgery for LDH (OR = 0.267).
CONCLUSIONS: BMI, genetic history, number of deliveries, simple hysterectomy, hypertriglyceridemia, and hyper-low-density lipoprotein cholesterolemia were independent risk factors for surgical treatment of both LDH and LSS in middle-aged and older women. Two disparities were found: labor intensity was a risk factor for LDH patients, and knee joint surgery and diabetes were risk factors for LSS patients.