腰椎后路融合术后邻近节段退变相关危险因素的Meta分析  

Meta-analysis of risk factors associated with adjacent segment degeneration after lumbar posterior fusion

作　　者：张腾飞[1] 王坤[1] 朱彦谕 梅伟[2] 王庆德[2] Zhang Tengfei;Wang Kun;Zhu Yanyu;Mei Wei;Wang Qingde(Second School of Clinical Medicine,Henan University of Chinese Medicine,Zhengzhou 450002,Henan Province,China;Dgpartment of Spinal Surgery,Zhengzhou Orthopedics Hospital,Zhengzhou 450052,Henan Province,China)

机构地区：[1]河南中医药大学第二临床医学院,河南省郑州市450002 [2]郑州市骨科医院脊柱外科,河南省郑州市450052

出　　处：《中国组织工程研究》2021年第12期1936-1943,共8页Chinese Journal of Tissue Engineering Research

基　　金：2018年郑州市科技惠民计划(河南省医学重点学科)(189PKJHM0780),项目负责人:梅伟。

摘　　要：目的:随着腰椎椎弓根内固定系统的发展,腰椎后路融合术在治疗腰椎退行性疾病上应用逐渐广泛,邻近节段退变是腰椎融合术后的远期并发症之一,影响术后邻近节段退变的危险因素较多,部分因素尚存争议,因此有必要进行系统分析。为此文章探讨腰椎后路融合术后发生邻近节段退变的相关危险因素。方法:计算机全面检索PubMed、The Cochrane Library、Embase、中国知网、万方和维普数据库,并手工检索中外影响因子较高的骨科类杂志,检索词主要包括"腰椎融合术""邻近节段退变""因素""ASD""risk factors"等,搜索年限为建库至2020年3月,包含腰椎后路融合术后发生邻近节段退变的单因素和(或)多因素分析。根据纳入及排除标准筛选文献后使用NOS量表严格评价文献质量。主要结局指标为年龄≥60岁,次要结局指标包括:性别(女)、吸烟史、体质量指数、骨质疏松、术前存在邻近节段退变、手术方式为后路椎间融合、融合节段>1、椎板切除和悬浮固定,其中体质量指数为连续型变量指标,其他均为二分类变量指标。提取相关数据后使用RevMan 5.3软件进行统计分析。结果:(1)共计18篇文献,其中14篇为高质量文献,中质量文献4篇,病例对照研究17篇,回顾性队列研究1篇,共纳入腰椎后路融合术后发生邻近节段退变患者568例,对照组2936例;(2)年龄≥60岁(OR=2.59,95%CI:1.83-3.67,P<0.00001)、吸烟史(OR=1.63,95%CI:1.17-2.26,P=0.004)、体质量指数(OR=3.54,95%CI:2.67-4.41,P<0.00001)、术前存在邻近节段椎间盘退变(OR=3.68,95%CI:2.85-4.76,P<0.00001)、融合节段>1(OR=1.82,95%CI:1.39-2.38,P<0.0001)均与腰椎后路融合术后发生邻近节段退变显著相关;(3)年龄≥60岁(OR=2.62,95%CI:1.71-4.02,P<0.00001)、术前存在邻近节段椎间盘退变(OR=4.45,95%CI:3.08-6.44,P<0.00001)、融合节段>1(OR=1.56,95%CI:1.06-2.31,P=0.03)均是腰椎后路融合术后发生邻近节段退变的独立危险OBJECTIVE:With the development of the lumbar pedicle internal fixation system,lumbar posterior fusion has been widely used in the treatment of degenerative diseases of the lumbar spine.Adjacent segment degeneration is one of the long-term complications after lumbar fusion.There are many risk factors affecting postoperative adjacent segment degeneration,some of which are still controversial,so it is necessary to conduct systematic analysis.Thus,this study investigated the risk factors of adjacent segment degeneration after posterior lumbar fusion.METHODS:A comprehensive computer search was conducted for PubMed,The Cochrane Library,Embase,CNKI,Wanfang,and VIP database.The major orthopedic journals with high impact factors in and outside China were manually searched.The search term mainly included"lumbar fusion","adjacent segment degeneration","factors","ASD"and"risk factors".The search period was from the database inception to March 2020,including the single-factor or multi-factor analysis of adjacent segment degeneration after lumbar posterior fusion.Literature quality was strictly evaluated using NOS scale after literature was screened according to inclusion and exclusion criteria.The primary outcome measure was age≥60 years.Secondary outcome measures included:gender(female),smoking history,body mass index,osteoporosis,preoperative presence of adjacent segment degeneration,surgical approach of posterior lumbar interbody fusion,fusion segment>1,laminectomy,and floating fusion.Among them,body mass index was a continuous variable index,and the rest were binary variables.Relevant data were extracted and statistically analyzed using RevMan 5.3 software.RESULTS:(1)A total of 18 literatures were included,among which 14 were of high quality,4 were of medium quality,17 were case control studies,and 1 was retrospective cohort study.A total of 568 patients with adjacent segment degeneration after lumbar posterior fusion were included,and 2936 patients in the control group were included.(2)Age≥60 years(OR=2.59,95%CI:1.83

关 键 词：骨 腰椎 退变 骨质疏松 危险因素 椎板 固定 并发症 META分析 

分 类 号：R459.9[医药卫生—治疗学] R605[医药卫生—临床医学]