目的:研究前外侧入路腰椎融合术(oblique lumbar interbody fusion, OLIF)术后发生融合器早期沉降的相关因素。方法:选择2020年4月至2024年4月在青岛市市立医院行前外侧入路腰椎融合术联合后路椎弓根螺钉内固定治疗腰椎退行性疾病的患者...目的:研究前外侧入路腰椎融合术(oblique lumbar interbody fusion, OLIF)术后发生融合器早期沉降的相关因素。方法:选择2020年4月至2024年4月在青岛市市立医院行前外侧入路腰椎融合术联合后路椎弓根螺钉内固定治疗腰椎退行性疾病的患者共137例为研究对象,统计一般资料,完成术前、术后3天内和随访(>6个月)的标准正侧位X线片,测量相关影像学参数。采用单因素分析及二元Logistic回归法分析融合器沉降的相关危险因素。结果:与未发生早期沉降的患者相比,发生早期沉降的患者Ward’s三角骨密度更低,术后椎间高度(前缘、均值)、椎间高度差值、随访椎间高度均值,融合器高–术后椎间高度更小。相较于早期发生Grade I型沉降的患者,发生Grade II型沉降的患者腰椎前凸角更大。结论:术前完善检查,合理制定手术方案有助于降低OLIF术后发生早期融合器沉降的概率。Objective: To explore the risk factors associated with cage early subsidence after oblique lumbar interbody fusion (OLIF) surgery. Methods: A total of 137 patients who underwent OLIF combined with posterior lumbar instrumentation for lumbar degenerative diseases at Qingdao Municipal Hospital between April 2020 and April 2024 were selected as the study subjects. General demographic data were collected, and standard anteroposterior and lateral X-rays were obtained preoperatively, within 3 days postoperatively, and during follow-up (>6 months). Relevant radiographic parameters were measured and analyzed. Univariate analysis and binary logistic regression were used to identify the relevant risk factors associated with cage subsidence. Results: Compared with patients who did not experience early subsidence, patients with early subsidence had lower bone mineral density in Ward’s triangle, smaller postoperative intervertebral height (anterior edge, mean value), smaller intervertebral height difference, smaller mean value of follow-up intervertebral height, and smaller cage height-postoperative intervertebral height. Compared with patients with early Grade I subsidence, patients with Grade II subsidence had a larger lumbar lordosis angle. Conclusion: Completing preoperative examinations and formulating reasonable surgical plans can help reduce the probability of early cage subsidence after OLIF.展开更多
目的评估基于磁共振成像(MRI)的腰肌质量参数对腰椎后路椎间融合术(PLIF)后融合器下沉的预测价值。方法对2019年2月至2023年2月接受单节段PLIF的165例病人进行回顾性研究,男75例,女90例,年龄为(65.02±8.55)岁。随访12个月以上,45例...目的评估基于磁共振成像(MRI)的腰肌质量参数对腰椎后路椎间融合术(PLIF)后融合器下沉的预测价值。方法对2019年2月至2023年2月接受单节段PLIF的165例病人进行回顾性研究,男75例,女90例,年龄为(65.02±8.55)岁。随访12个月以上,45例(27.3%)发生融合器沉降,根据是否发生术后融合器沉降分为沉降组(45例)与非沉降组(120例)。术前在MRI上测量腰肌指数(PMI)和腰肌质量评分(Goutallier分级),以及椎体骨质量(vertebral bone quality,VBQ)、终板骨质量(endplate bone quality,EBQ);基于CT,测量计算机断层扫描(QCT)骨密度值。比较两组病人的年龄、性别、身体质量指数(BMI)、手术节段、PMI、Goutallier分级等;采用Logistic回归分析融合器下沉的影响因素;PMI、Goutallier分级分别与融合器沉降高度、QCT骨密度值进行相关性分析;比较不同手术节段中的PMI、Goutallier分级;绘制受试者工作特征曲线(ROC),计算各预测因子的曲线下面积(AUC)。结果沉降组与非沉降组的年龄、性别、BMI、Goutallier分级、PMI、VBQ、EBQ比较,差异有统计学意义(P<0.05)。Logistic回归分析结果显示年龄、性别、QCT骨密度值、VBQ、PMI、Goutallier分级是融合器沉降的影响因素。相关性分析结果显示PMI与融合器沉降高度呈显著负相关(r=-0.402,P<0.05),与QCT骨密度值呈显著正相关(r=3.390,P<0.05);Goutallier分级与融合器沉降高度呈正相关(r=0.289,P<0.05),与QCT骨密度值呈负相关(r=-0.286,P<0.05),与PMI呈负相关(r=-0.462,P<0.05)。PMI的AUC为0.826(95%CI:0.756,0.896),最佳沉降边界为6.94 cm^(2)/m^(2),Goutallier分级的AUC为0.786(95%CI:0.719,0.854),最佳沉降边界1.5级。结论PMI和Goutallier分级可能是PLIF术后融合器沉降的重要预测指标。展开更多
文摘目的:研究前外侧入路腰椎融合术(oblique lumbar interbody fusion, OLIF)术后发生融合器早期沉降的相关因素。方法:选择2020年4月至2024年4月在青岛市市立医院行前外侧入路腰椎融合术联合后路椎弓根螺钉内固定治疗腰椎退行性疾病的患者共137例为研究对象,统计一般资料,完成术前、术后3天内和随访(>6个月)的标准正侧位X线片,测量相关影像学参数。采用单因素分析及二元Logistic回归法分析融合器沉降的相关危险因素。结果:与未发生早期沉降的患者相比,发生早期沉降的患者Ward’s三角骨密度更低,术后椎间高度(前缘、均值)、椎间高度差值、随访椎间高度均值,融合器高–术后椎间高度更小。相较于早期发生Grade I型沉降的患者,发生Grade II型沉降的患者腰椎前凸角更大。结论:术前完善检查,合理制定手术方案有助于降低OLIF术后发生早期融合器沉降的概率。Objective: To explore the risk factors associated with cage early subsidence after oblique lumbar interbody fusion (OLIF) surgery. Methods: A total of 137 patients who underwent OLIF combined with posterior lumbar instrumentation for lumbar degenerative diseases at Qingdao Municipal Hospital between April 2020 and April 2024 were selected as the study subjects. General demographic data were collected, and standard anteroposterior and lateral X-rays were obtained preoperatively, within 3 days postoperatively, and during follow-up (>6 months). Relevant radiographic parameters were measured and analyzed. Univariate analysis and binary logistic regression were used to identify the relevant risk factors associated with cage subsidence. Results: Compared with patients who did not experience early subsidence, patients with early subsidence had lower bone mineral density in Ward’s triangle, smaller postoperative intervertebral height (anterior edge, mean value), smaller intervertebral height difference, smaller mean value of follow-up intervertebral height, and smaller cage height-postoperative intervertebral height. Compared with patients with early Grade I subsidence, patients with Grade II subsidence had a larger lumbar lordosis angle. Conclusion: Completing preoperative examinations and formulating reasonable surgical plans can help reduce the probability of early cage subsidence after OLIF.
文摘目的评估基于磁共振成像(MRI)的腰肌质量参数对腰椎后路椎间融合术(PLIF)后融合器下沉的预测价值。方法对2019年2月至2023年2月接受单节段PLIF的165例病人进行回顾性研究,男75例,女90例,年龄为(65.02±8.55)岁。随访12个月以上,45例(27.3%)发生融合器沉降,根据是否发生术后融合器沉降分为沉降组(45例)与非沉降组(120例)。术前在MRI上测量腰肌指数(PMI)和腰肌质量评分(Goutallier分级),以及椎体骨质量(vertebral bone quality,VBQ)、终板骨质量(endplate bone quality,EBQ);基于CT,测量计算机断层扫描(QCT)骨密度值。比较两组病人的年龄、性别、身体质量指数(BMI)、手术节段、PMI、Goutallier分级等;采用Logistic回归分析融合器下沉的影响因素;PMI、Goutallier分级分别与融合器沉降高度、QCT骨密度值进行相关性分析;比较不同手术节段中的PMI、Goutallier分级;绘制受试者工作特征曲线(ROC),计算各预测因子的曲线下面积(AUC)。结果沉降组与非沉降组的年龄、性别、BMI、Goutallier分级、PMI、VBQ、EBQ比较,差异有统计学意义(P<0.05)。Logistic回归分析结果显示年龄、性别、QCT骨密度值、VBQ、PMI、Goutallier分级是融合器沉降的影响因素。相关性分析结果显示PMI与融合器沉降高度呈显著负相关(r=-0.402,P<0.05),与QCT骨密度值呈显著正相关(r=3.390,P<0.05);Goutallier分级与融合器沉降高度呈正相关(r=0.289,P<0.05),与QCT骨密度值呈负相关(r=-0.286,P<0.05),与PMI呈负相关(r=-0.462,P<0.05)。PMI的AUC为0.826(95%CI:0.756,0.896),最佳沉降边界为6.94 cm^(2)/m^(2),Goutallier分级的AUC为0.786(95%CI:0.719,0.854),最佳沉降边界1.5级。结论PMI和Goutallier分级可能是PLIF术后融合器沉降的重要预测指标。
