| 张慰.经椎间孔椎体间融合术治疗单节段腰椎退行性疾病术后融合器下沉及危险因素分析[J].安徽医药,2020,24(5):972-976. |
| 经椎间孔椎体间融合术治疗单节段腰椎退行性疾病术后融合器下沉及危险因素分析 |
| The analysis of risk factors of cage subsidence of the single level lumbar spine degenerative diseases treating with transforaminal lumbar interbody fusion |
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| DOI：10.3969/j.issn.1009?6469.2020.05.032 |
| 中文关键词: 椎间盘退行性变 脊柱融合术 /副作用 经椎间孔椎体间融合术 融合器下沉 危险因素 |
| 英文关键词: Intervertebral disc degeneration Spinal fusion/adverse effects Transforaminal interbody fusion Cage subsid? ence Risk factor |
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| 中文摘要: |
| 目的分析经椎间孔椎体间融合术( minimal invasive posterior transforamen lumbar interbody fusion，TLIF)治疗的单节段腰椎退行性疾病病人术后融合器下沉情况及其影响因素。方法选取 2014年 9月至 2018年 3月天长市人民医院收治的腰椎退行性疾病病人 78例，根据病人术后椎间隙丢失值将病人分为两组，其中融合器下沉组( ≥2 mm)10例，男性 6例，女性 4例，年龄( 53.8±7.2)岁；融合器未下沉组(＜ 2 mm)68例，男性 37例，女性 31例，年龄( 54.1±10.1)岁。分析病人在随访过程中的视觉模拟( VAS)评分、 Oswestry功能障碍指数问卷表( ODI)评分、末次随访椎间融合率以及腰椎曲度，通过单因素统计分析及多因素 logistic回归分析探讨 TLIF术后融合器下沉的原因及独立危险因素。绘制 ROC曲线并计算曲线下面积。结果本次研究中融合器下沉发生率为 12.8%(10/78)两组病人一般资料的比较(年龄、性别、吸烟史、体智联指数、随访时间)差异无统计学意义(P＞0.05)融合器下沉组病人术前术，后融合节段椎间隙高度( IH)及术后节段性前凸角( SA)均高于未下沉组( P＜0.05)，而且术后两周腰疼，VAS评分及术后 6个月 ODI功能障碍评分低于融合器未下沉组( P＜0.05)，经 spearman相关分析，病人术后 IH、 SA与术后 6个月 ODI、术后两周 VAS评分的相关性分别为 r＝-0.249(P＝0.028)、 r＝-0.004(P＝0.973)及 r＝-0.244(P＝ 0.032)、 r＝-0.231(P＝0.042)。 logistic回归结果显示影响病人 TLIF术后发生融合器下沉的危险因素为术后 IH(OR＝1.62， 95%CI:1.05~2.48)及 SA(OR＝1.92，95%CI:1.12~3.33)ROC曲线分析结果显示，术后 IH对病人融合器下沉鉴别的曲线下面积为 0.696(0.575~0.816)(P＝0.003)；术后 SA对病人融合器，下沉鉴别的曲线下面积为 0.701(0.579~0.823)(P＝0.002)。结论病人 TLIF术后节段椎间隙高度、术后节段性前凸角是融合器下沉的独立危险因素，临床上应关注术后椎间隙增加的单节段腰椎退行性疾病病人，采取有效的措施降低病人术后融合器下沉的发生风险。 |
| 英文摘要: |
| Objective To analyze the rate and risk factors of cage subsidence of patients with single level lumbar spine degenera?tive diseases treating with transfo?raminal lumbar interbody fusion(TLIF).Methods The clinical data of 78 patients with single? segmental lumbar degenerative disease enrolled in The People’s Hospital of Tianchang from Sept.2014 to Mar.2018，treated with TLIF were analyzed.According to the loss value of postoperative intervertebral space，the patients were divided into two groups，in? cluding 10 patients in the cage subsidence group(≥2 mm)6 males and 4 females，with an average age of(53.8±7.2)years.There were 68 cases(＜ 2 mm)in the non?cage subsidence group，i，ncluding 37 males and 31 females，with an average age of(54.1±10.1) years.The Visual analogue scores(VAS)score，Osestry disability index(ODI)score，intervertebral fusion rate and lumbar curva? ture during the last follow?up were analyzed during the follow?up.Univariate statistical analysis and multivariate logistic regressionanalysis were used to investigate the causes and independent risk factors for the subsidence of the fusion cage after TLIF surgery， and the ROC curve was draw to calculate the area under the curve.Results The rate of cage subsidence was 12.8%(10/78)there was no statistically significant difference the comparison of the general information for patients in two groups(age，gender，，smoking history，BMI，and follow?up time)( P＞0.05).The preoperative IH，postoperative IH and postoperative SA of the cage sub? sidence group were higher than the non?cage subsidence group(P＜0.05).The VAS score of lumbar pain two weeks after the opera?tive and the ODI scores after 6 months of surgery were lower than that of non?cage subsidence group(P＜0.05).Spearman correla? tion analysis showed that the correlation between IH and ODI and VAS score were -0.249(P＝0.028)and -0.004(P＝0.973). The correlation between SA and ODI and VAS score was -0.244(P＝0.032)and -0.231(P＝0.042).The results of Logistic re? gression showed that postoperative IH(OR＝1.62，95%CI:1.05?2.48)and SA OR＝1.92，95%CI:1.12?3.33)were the main risk fac? tors for the occurrence of cage subsidence after TLIF.The result of ROC curve analysis showed that the area under the curve ofpostoperative IH in the differentiation of cage subsidence was 0.696(0.575?0.816)( P＝0.003).The area under the curve of postop? erative SA for the differentiation of cage subsidence was 0.701(0.579?0.823)( P＝0.002).Conclusion The height of the interver?tebral space and the angle of segmental lordosis after TLIF surgery are the independent risk factors for the cage subsidence.There?fore，patients with single?segment lumbar degenerative disease with increased intervertebral space should be concerned clinically， and effective measures should be taken to reduce the risk of the cage subsidence after TLIF surgery |
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