背景:研究人员最近将子宫切除术联系起来,改变性激素水平,像骨质疏松症这样的疾病,腰椎滑脱,高血压和糖尿病等.然而,子宫切除术与腰椎间盘突出症(LDH)/腰椎管狭窄症(LSS)之间的关联尚不清楚.
目的:为了确定子宫切除术与女性LDH/LSS的手术干预之间是否存在相关性,通过影像学和临床研究进一步证实。
方法:病例对照和队列研究。
方法:研究组包括1202名45岁及以上因LDH/LSS而接受手术治疗的女性患者(LDH为825名,LSS为377名)。对照组为同期就诊于健康体检诊所的1168名无腰椎疾病的女性。进一步选择了一百零二位子宫切除患者(子宫切除术队列),并以1:2的比例与对照组大致匹配,最少随访2年。
方法:计算赔率比(ORs)和95%置信区间(CIs),以评估子宫切除术与女性LDH/LSS手术干预之间的相关性。对子宫切除术和对照组的患者进行了全面评估。该评估包括对几个参数的评估:功能横截面积,脂肪浸润率,腰椎旁肌肉的相对功能横截面积,小关节退变等级,软骨终板损伤,L3/4-L5/S1段的修改更改,腰椎间盘退变的Pfirrmann分级,和L1/2-L5/S1段的圆盘高度指数。此外,我们在术前和末次随访时记录视觉模拟量表(VAS)和日本骨科协会(JOA)评分.
方法:使用多变量二项logistic回归分析子宫切除术与LDH或LSS手术患者之间的关联。腰椎X光片,计算机断层扫描(CT)和磁共振成像(MRI)用于评估成像变量.比较了影像学和临床变量。
结果:子宫切除的妇女因LDH/LSS而需要手术,ORs为2.613(P<0.001)和2.084(P=0.006),分别。影像学评估进一步显示,子宫切除术队列有更严重的椎旁肌肉变性,面关节,端板,和椎间盘,L3/4-L5/S1段的修改变化,与对照组相比,L1/2-L5/S1节段的椎间高度降低(P<0.01)。与对照组相比,子宫切除术队列对下腰背痛的术前和最后一次随访VAS评分较高,末次随访JOA评分(P<0.01)。
结论:根据本研究的结果,子宫切除术的女性似乎与LDH/LSS需要手术干预相关.影像学和临床研究还表明,子宫切除患者表现出更严重的腰椎退变和背痛。
BACKGROUND: Researchers have recently linked hysterectomy, which alters sex hormone levels, to diseases like osteoporosis, lumbar spondylolisthesis, hypertension and diabetes etc. However, the association between hysterectomy and lumbar disc herniation (LDH)/lumbar spinal stenosis (LSS) remains unclarified.
OBJECTIVE: To determine whether there is a correlation between hysterectomy and surgical intervention for LDH/LSS in women, further substantiated through imaging and clinical research.
METHODS: A case control and cohort study.
METHODS: The study group comprised 1202 female patients aged 45 and older who had undergone operative treatment due to LDH/LSS (825 for LDH and 377 for LSS), and the comparison group comprised 1168 females without lumbar diseases who visited health examination clinic during the same period. One hundred and two hysterectomized patients were further selected (Hysterectomy cohort) and matched approximately with the control cohort at a 1:2 ratio from the study group with a minimum follow-up of 2 years.
METHODS: Odds Ratios (ORs) and 95% Confidence Intervals (CIs) were calculated to assess the association between hysterectomy and surgical intervention for LDH/LSS in women after adjusted by confounding factors. Patients from both the hysterectomy and control cohorts underwent a comprehensive assessment. This assessment included the evaluation of several parameters: the functional cross-sectional area, fat infiltration rate, relative functional cross-sectional area of the lumbar paravertebral muscles, facet joint degeneration grade, cartilage endplate damage, Modic changes for the L3/4-L5/S1 segments, Pfirrmann grade of lumbar disc degeneration, and disc height index for the L1/2-L5/S1 segments. Additionally, the Visual Analog Scale (VAS) and Japanese Orthopaedic Association (JOA) scores were recorded preoperatively and at the last follow-up.
METHODS: Associations between hysterectomy and patients treated surgically for LDH or LSS were analyzed using multivariate binomial logistic regression analysis. Lumbar X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) were used to evaluate the imaging variables. Imaging and clinical variables were compared.
RESULTS: Hysterectomized women were associated with requiring surgery due to LDH/LSS, with ORs of 2.613 (P < 0.001) and 2.084 (P = 0.006), respectively. The imaging evaluation further revealed that the hysterectomy cohort had more severe degeneration of the paraspinal muscles, facet joints, endplates, and intervertebral discs, Modic changes at L3/4-L5/S1 segments, and intervertebral height reduction at L1/2-L5/S1 segments when compared to the control cohort (P < 0.01). Compared to the control cohort, the hysterectomy cohort exhibited higher preoperative and last follow-up VAS scores for low back pain, and last follow-up JOA scores (P < 0.01).
CONCLUSIONS: Based on the findings of this study, it seems that women who have had a hysterectomy are correlated with requiring surgical intervention due to LDH/LSS. Imaging and clinical studies also indicate that hysterectomized patients exhibited more severe lumbar degeneration and back pain.