腰椎管狭窄症行椎板切除术后发生峡部周围骨折的风险因素观察  

Observation of risk factors for post-laminectomy fracture around isthmus

作　　者：刘巍巍 冯振中 瞿娜娜 加鹏飞 LIU Wei-wei;FENG Zhen-zhong;QU Na-na;JIA Peng-fei(Spinal Surgery department,Suizhou Central Hospital,Suizhou,Hubei441300,China;Hubei provincial Hospital of Integrated Chinese&Westerm Medicine,Wuhan 430015,China)

机构地区：[1]随州市中心医院脊柱外科,湖北随州441300 [2]湖北省中西医结合医院,湖北武汉430015

出　　处：《颈腰痛杂志》2023年第4期586-589,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的回顾性分析腰椎管狭窄症患者行椎板切除术后发生峡部周围骨折(post-laminectomy fracture around the isthmus,PLFAI)的风险因素。方法选择2016年1月~2019年12月因腰椎管狭窄症在本院接受减压手术的141例患者资料进行回顾性分析,记录患者年龄、性别、体质量指数(body mass index,BMI)、糖尿病史、类固醇应用、手术时间、术中失血量、减压节段数量、全椎板切除减压水平分布、矢状纵轴(sagittal vertical axis,SVA)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、腰椎前凸角(lumbar lordosis,LL)、腰椎侧凸发生率,观察影响PLFAI的风险因素。结果PLFAI发生率18.44%。与PLFAI相关的因素包括糖尿病、Cobb角、腰椎侧凸、手术时间、L_(4)全椎板切除术(P均<0.05),与PLFAI无关的因素包括性别、年龄、体质量指数、激素应用、SVA、PI、LL、PI-LL、椎体滑脱、术中失血量(P均>0.05)。多因素Logistic回归分析显示,糖尿病、L_(4)全椎板切除和腰椎侧凸是发生PLFAI的风险因素(P<0.05)。结论脊柱侧凸、糖尿病、L_(4)全椎板切除术可能是PLFAI的风险因素,对于腰椎侧凸或糖尿病患者,应尽可能避免行L_(4)全椎板切除术,以降低PLFAI的发生风险。Objective To investigate the risk factors of post-laminectomy fracture around the isthmus(PLFAI).Methods The data of 141 patients with lumbar spinal stenosis who underwent decompression surgery in our hospital from January 2016 to December 2019 were analyzed retrospectively.Age,gender,body mass index(BMI),history of diabetes,steroid use,operative time,intraoperative blood loss,decompression level,total laminectomy,decompression,horizontal sagittal vertical axis(SVA),pelvic incidenceangle(PI),pelvic tilt angle(PT),lumbar lordosis(LL),and lumbar scoliosis were recorded,and risk factors affecting PLFAI were observed.Results The incidence of PLFAIwas 18.44%.Factors related to PLFAI included diabetes,Cobb angle,lumbar scoliosis,operative time and L_(4)total laminectomy(P<0.05).Factors unrelated to PLFAI included gender,age,body mass index,hormone application,SVA,PI,LL,PI-LL,spondylolisthesis and intraoperative blood loss(all P>0.05).Multivariate logistic analysis showed that diabetes,L_(4)laminectomy and scoliosis were risk factors for PLFAI(P<0.05).Conclusion Scoliosis,diabetes and L_(4)total laminectomy may be risk factors for PLFAI.For lumbar scoliosis or diabetes,L_(4)total laminectomy should be avoided wheneverpossible to reduce the risk of PLFAI.

关 键 词：腰椎管狭窄症 糖尿病 术后峡部周围骨折 腰椎侧凸 

分 类 号：R619[医药卫生—外科学]