单节段斜外侧腰椎间融合术后腰痛的危险因素分析  

Correlative factors of low back pain after single-level oblique lateral interbody fusion

作　　者：高显达[1] 马雷[1] 赵若宇 杜沛宇 丁文元[1] Gao Xianda;Ma Lei;Zhao Ruoyu;Du Peiyu;Ding Wenyuan(Department of Spine Surgery,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院脊柱外科,石家庄050051

出　　处：《中华骨科杂志》2021年第18期1342-1349,共8页Chinese Journal of Orthopaedics

摘　　要：目的分析单节段斜外侧腰椎间融合术(oblique lateral interbody fusion,OLIF)后腰痛的危险因素。方法回顾性分析2016年5月至2019年9月因腰椎退行性疾病接受单节段OLIF手术治疗93例患者的病历资料,男55例,女38例;年龄(55.73±9.48)岁(范围32~78岁)。L3,4节段18例(19.35%),L4,5节段73例(78.50%),L5S1节段2例(2.15%)。单纯OLIF手术43例,OLIF联合侧或后方内固定术50例。随访时间为(22.86±5.90)个月(范围12~32个月)。根据末次随访时腰部疼痛视觉模拟评分(visual analogue scale,VAS)≥3分,分为腰痛组和无腰痛组。记录两组患者人口学特征(年龄、性别、体质指数、合并基础疾病)、手术基本资料(手术节段、手术方式、手术时间、术中出血量、术中是否存在骨性终板损伤)、影像学资料(腰椎前凸角、节段前凸角、椎间隙高度、融合器沉降)和腰椎功能。对潜在的危险因素首先行单因素分析,其中P<0.05的因素纳入多因素Logistic回归模型,采用多因素Logistic回归分析确定OLIF术后腰痛的危险因素。结果末次随访时19例患者腰痛VAS评分≥3分,纳入腰痛组;余74例纳入无腰痛组。两组患者的年龄、性别、体质指数、随访时间、合并基础疾病等基线资料的差异均无统计学意义。两组术前腰痛VAS评分差异无统计学意义(t=0.818,P=0.414),而末次随访时的差异有统计学意义(t=6.958,P<0.001)。腰痛组患者骨质疏松发生率(63.16%)明显高于无腰痛组(25.68%),差异有统计学意义(t=9.558,P=0.002)。两组患者术前椎间隙高度的差异无统计学意义(t=1.008,P=0.316),而末次随访时无腰痛组椎间隙高度明显高于腰痛组(t=2.537,P=0.013);无腰痛组融合器沉降发生率为8.11%,明显低于腰痛组的36.84%(t=10.381,P=0.001)。多因素Logistic回归分析显示骨质疏松(P=0.009)、术中骨性终板损伤(P=0.031)、椎间隙高度下降(P=0.029)、融合器沉降(P=0.016)是单节段OLIF术后腰痛的危险因素。Objective The study retrospectively identified the correlative factors of low back pain after single-level oblique lateral interbody fusion(OLIF).Methods Records of 93 patients(55 males and 38 females)who underwent OLIF(oblique lateral interbody fusion)surgery for lumbar degenerative diseases from May 2016 to September 2019 were analyzed retrospectively and patients'age was 55.73±9.48 years(range 32-78 years).There were 18 patients underwent L 3,4 segment(19.35%),73 patients underwent L 4,5 segment(78.50%),and 2 patients underwent L 5S1 segment(2.15%).There were 43 patients underwent OLIF stand alone and 50 patients underwent OLIF combined with lateral or posterior internal fixation.The follow-up time was 22.86±5.90 months(range 12-32 months).According to whether the visual analog scale(VAS)≥3 at the last follow-up visit,the patients were divided into low back pain group and no low back pain group.The demographic characteristics(age,gender,body mass index and comorbidities),basic surgical data(surgical segments,surgical methods,surgical time,intraoperative bleeding,endplate injury or not during operation),imaging data(lumbar lordosis,segmental lordosis,intervertebral height and cage subside)and lumbar function were recorded.The potential related factors were analyzed by univariate analysis,and the factors with P<0.05 were selected in the multivariate logistic regression model.Then the risk factors of low back pain after OLIF were determined by multivariate logistic regression analysis.Results Nineteen patients with VAS score equal or greater than 3 were included in low back pain group,and the remaining 74 patients were included in no low back pain group.There was no significant difference in baseline data such as age,gender,BMI,follow-up time and comorbidities between two groups.There was no significant difference in VAS score between the two groups before operation(t=0.818,P=0.414),but there was significant difference in VAS score at last follow-up visit(t=6.958,P<0.001).The incidence rate of osteoporosis in

关 键 词：腰椎 脊柱融合术 手术后并发症 腰痛 危险因素 

分 类 号：R687.3[医药卫生—骨科学]