骨质疏松症患者后路腰椎椎间融合术后融合器下沉的危险因素分析:前瞻性队列研究  

Risk factors for cage subsidence after posterior lumbar interbody fusion in osteoporotic patients: a prospective cohort study

作　　者：尚泽森 邹达[1] 赵祎 范东伟[1] 齐强[1] 郭昭庆[1] 李危石[1] SHANG Zesen;ZOU Da;ZHAO Yi;FAN Dongwei;QI Qiang;GUO Zhaoqing;LI Weishi(Department of Orthopaedics,The Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院骨科,北京100191

出　　处：《中华骨与关节外科杂志》2022年第9期656-661,共6页Chinese Journal of Bone and Joint Surgery

基　　金：北京大学第三医院临床队列建设项目(BYSYDL2019006)。

摘　　要：目的:探索骨质疏松症患者后路腰椎融合术后融合器(cage)下沉的危险因素。方法:本研究前瞻性纳入2021年1月至2021年12月因腰椎退行性疾病接受后路腰椎椎间融合术的骨质疏松症患者59例,随访至少6个月。收集患者一般资料、最低T值、L1椎体CT值、椎间融合节段、cage高度、术后6个月cage下沉率和植骨融合率。本研究骨质疏松诊断标准为T值≤-2.5或L1椎体CT值≤110 HU,L1椎体CT值≤80 HU记为重度骨质疏松。术后即刻X线中cage下沉>2 mm定义为终板损伤。术后6个月下沉>2 mm记为下沉,下沉>4 mm记为重度下沉。腰椎X线检查提示无椎间不稳且腰椎CT提示融合节段终板间连续植骨块形成记为融合。结果:术后6个月,以患者统计,cage下沉率71.2%(42/59),重度下沉率37.3%(22/59)。重度下沉组与非重度下沉组相比,L1椎体CT值更低[(80.6±23.3)HU vs.(94.0±24.8)HU,P=0.044],其他指标差异无统计学意义。共90个椎间融合节段,以融合节段统计,重度下沉节段的cage高度更大[(12.2±2.0)mm vs.(10.2±1.8)mm,P<0.001],CT值更低[(78.7±24.4)HU vs.(95.0±23.8)HU,P=0.006]。17.8%(16/90)的节段存在终板损伤。终板损伤节段的重度下沉率高于无损伤节段(81.3%vs. 13.5%,P<0.001)。Logistic回归分析提示终板损伤、cage高度≥12 mm、重度骨质疏松症(L1椎体CT值≤80 HU)是cage重度下沉的独立危险因素。结论:骨质疏松症患者行后路椎间融合术时要注意保护终板,避免使用高度过大的融合器。对于L1椎体CT值≤80 HU的重度骨质疏松症患者,要谨慎选择椎间融合术,注意抗骨质疏松治疗。Objective: To explore the risk factors for cage subsidence after posterior lumbar interbody fusion in osteoporotic patients.Methods: A total of 59 osteoporotic patients undergoing posterior lumbar interbody fusion for lumbar degenerative diseases from January 2021 to December 2021 were prospectively studied. The minimal follow-up was 6 months. This study collected the general information, the lowest T-score, L1 vertebral CT value, the level of interbody fusion, cage height and etc. The criteria for diagnosing osteoporosis was the lowest T-score≤-2.5 or L1-CT value≤110 HU, the patients with L1-CT value≤80 HU was diagnosed as severe osteoporosis. The endplate injury was defined as cage subsidence>2 mm in immediate postoperative X-ray. At 6-month follow-up, cage subsidence was defined as a displacement of cages by>2 mm into the endplates. Cage subsidence>4 mm was defined as severe subsidence. The successful fusion status was defined as continuous fusion mass across the endplates without segmental instability.Results: At 6-months follow-up, the cage subsidence rate(counted in patients) was 71.2%(42/59), and severe subsidence rate was37.3%(22/59). The general information was comparable between the subsidence group and non-subsidence group. The severe subsidence group showed lower L1-CT value than non-severe subsidence group([80.6±23.3] HU vs. [94.0±24.8] HU, P=0.044), and the other indexes were comparable between the two groups. There were 90 levels of interbody fusion. The severe subsidence levels showed higher cage height([12.2±2.0] mm vs. [10.2±1.8] mm, P<0.001) and lower CT value([78.7±24.4] HU vs. [95.0±23.8] HU, P=0.006) than the non-severe subsidence levels. The endplate injury rate was 17.8%(16/90). The endplate injury group showed higher subsidence rate than the non-injury group(81.3% vs. 13.5%, P<0.001). The logistic regression analysis indicated that the endplate injury, cage height≥12 mm, severe osteoporosis(L1-CT value≤80 HU) were the independent risk factors for severe subsidence.Conclusi

关 键 词：骨质疏松 后路腰椎椎间融合术 融合器下沉 前瞻性队列研究 

分 类 号：R687.3[医药卫生—骨科学]