基于MRI椎体和终板骨质量评分对经椎间孔椎间融合术后cage沉降的预测价值  

Predictive value of MRI-based vertebral bone quality score and endplate bone quality score for cage subsidence after transforaminal lumbar interbody fusion

作　　者：罗顿 陈骞 艾有为 朱策 王珏翰 丁鸿 刘立岷[1] LUO Dun;CHEN Qian;AI You-wei;ZHU Ce;WANG Jue-han;DING Hong;LIU Li-min(Department of Orthopedic Surgery and Orthopedic Research Institute,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院骨科,四川成都610000

出　　处：《实用医院临床杂志》2024年第3期20-25,共6页Practical Journal of Clinical Medicine

基　　金：四川省科技厅重大科技专项(编号:2022ZDZX0029)。

摘　　要：目的探讨基于MRI的椎体骨质量评分(vertebral bone quality score,VBQ)和终板骨质量评分(endplate bone quality score,EBQ)在经椎间孔腰椎椎间融合(transforaminal lumbar interbody fusion,TLIF)术后cage沉降中的预测价值。方法因腰椎退行性疾病在我院行TLIF手术的226例患者,根据术后有无cage沉降将患者分为沉降组和非沉降组,比较两组患者VBQ和EBQ评分。通过多元回归分析cage沉降的危险因素,并根据受试者工作特征曲线下面积(AUC)评估VBQ和EBQ预测TLIF术后cage沉降的能力。结果226例患者中30例出现术后cage沉降。沉降组VBQ(3.8±0.4)分,EBQ(5.1±0.7)分,明显高于非沉降组(3.1±0.6)分和(4.2±1.0)分,差异有统计学意义(P<0.001)。多元回归分析显示VBQ(OR=4.258,95%CI:1.983~9.142,P<0.001)和EBQ(OR=1.971,95%CI:1.212~3.203,P=0.006)评分越高,发生cage沉降风险也越大。受试者工作特征曲线结果显示VBQ的AUC为0.843,EBQ的AUC是0.864。VBQ和EBQ预测cage沉降的最佳阈值分别为3.480(敏感性90%;特异性75.5%)和4.620(敏感性96.7%;特异性74.5%)。结论术前VBQ或EBQ评分越高,TLIF术后发生cage沉降风险越大。其中EBQ可能是一个更好的预测融合术后cage沉降的指标。Objective To explore the predictive value of MRI-based vertebral bone quality(VBQ)score and endplate bone quality(EBQ)score for cage subsidence after transforaminal lumbar interbody fusion(TLIF).Methods Two hundred and twenty-six patients undergoing TLIF for degenerative lumbar disease in our hospital were selected.The patients were divided into a subsidence group and a non-subsidence group according to whether there was cage subsidence after surgery.The scores of VBQ and EBQ were compared between the two groups.Risk factors for cage subsidence were investigated by using multivariate logistic regression analysis.The VBQ and EBQ scores were assessed for their ability to predict cage subsidence in patients based on the area under the receiver operative characteristic curve(AUC).Results Among the 226 patients,there were 30 with cage subsidence.The VBQ scores were(3.8+0.4)and the EBQ scores were 5.1+0.7 in the subsidence group.These were significantly higher than VBQ scores(3.1+0.6)and EBQ scores(4.2+1.0)in the non-subsidence group(P<0.001).Multiple regression analysis showed that a higher risk of subsidence was associated with a higher VBQ score(OR=4.258,95%CI:1.983~9.142,P<0.001)and a higher EBQ score(OR=1.971,95%CI:1.212~3.203,P=0.006).The ROC curve analysis showed that the AUC of VBQ was 0.843 and the AUC of EBQ was 0.864,respectively.The optimal thresholds for VBQ and EBQ scores to predict cage subsidence were 3.480(sensitivity=90%and specificity=75.5%)and 4.620(sensitivity=96.7%and specificity=74.5%),respectively.Conclusions The higher the preoperative VBQ or EBQ scores,the higher the risk of postoperative cage subsidence after TLIF.Among the two indicators,EBQ may be a better predictor of cage subsidence after fusion.

关 键 词：椎体骨质量评分 终板骨质量评分 磁共振 经椎间孔椎间融合术 Cage沉降 

分 类 号：R687.3[医药卫生—骨科学]