脊柱-骨盆矢状面参数和腰椎前凸分布指数对短节段腰椎融合术后邻近节段退变的影响  

Effect of spinopelvic sagittal alignment and lordosis distribution index on adjacent segment degeneration after short-segment lumbar interbody fusion

作　　者：王鑫 周栋 王牧一 徐南伟 蒋羽清 邱勇[3] 孙旭[3] 沈益飞 Wang Xin;Zhou Dong;Wang Muyi;Xu Nanwei;Jiang Yuqing;Qiu Yong;Sun Xu;Shen Yifei(Department of Orthopaedics,The Affiliated Changzhou Second People's Hospital of Nanjing Medical University,Changzhou 213000,China;Department of Orthopaedics,Changzhou Children's Hospital,Changzhou 213000,China;Department of Orthopaedic Surgery,Division of Spine Surgery,Affiliated Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属常州第二人民医院骨科,常州213000 [2]常州市儿童医院骨科,常州213000 [3]南京大学医学院附属鼓楼医院脊柱外科,南京210008

出　　处：《中华骨科杂志》2024年第8期553-560,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金区域基金(82160555);新疆维吾尔自治区自然科学基金面上项目(2022D01A317);常州医学中心项目(CMCB202216)。

摘　　要：目的探讨脊柱-骨盆矢状面参数和腰椎前凸分布指数对短节段腰椎融合术后邻近节段退变(adjacent segment degeneration,ASD)的影响。方法回顾性分析2009年1月至2019年1月南京医科大学附属常州市第二人民医院和南京大学医学院附属鼓楼医院因腰椎退变性疾病接受后路椎间融合手术的患者234例,男102例、女132例,年龄(60.1±10.0)岁(范围41~78岁)。根据术后是否出现ASD分为ASD组和无ASD组。比较两组患者的一般资料及手术前后的骨盆入射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)、骨盆倾斜角(pelvic tilt,PT)、腰椎前凸角(lumbar lordosis,LL)、下腰椎前凸角(distal lordosis,DL)、融合节段前凸角(segmental lordosis,SL)、腰椎前凸分布指数(lordosis distribution index,LDI)和矢状面平衡(sagittal vertical axis,SVA)。采用二分类logistic回归分析腰椎融合术后发生ASD的独立危险因素。绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),计算各独立危险因素的曲线下面积。结果所有患者均顺利完成手术并获得随访,随访时间为(70.6±11.9)个月(范围60~121个月)。234例患者中116例术后发生ASD。ASD组与无ASD组年龄(t=2.697,P=0.008)、融合节段(χ2=16.439,P<0.001)、术前PT(t=2.268,P=0.024)、术前LL(t=2.042,P=0.042)、术前DL(t=2.724,P=0.007)、术后DL(t=3.104,P=0.002)、术后LDI(t=2.063,P=0.040)及手术前后SVA差值(Z=2.001,P=0.045)的差异有统计学意义。二分类logistic回归分析结果显示术后LDI降低(OR=0.971,P=0.002)、双节段融合(OR=3.477,P<0.001)、手术前后SVA差值增加(OR=0.992,P=0.039)是腰椎融合术后发生ASD的独立危险因素。ROC曲线显示融合节段数、术后LDI、手术前后SVA差值的曲线下面积及95%CI分别为0.633(0.561,0.704)、0.583(0.510,0.656)和0.576(0.502,0.649)。联合预测模型的曲线下面积为0.702,预测价值为中。结论双节段融合、术后LDI降低、手术前后SVA差值增加是腰�Objective To investigate the effect of spinopelvic sagittal alignment and lordosis distribution index on adjacent segment degeneration(ASD)after short-segment lumbar interbody fusion.Methods A total of 234 patients who underwent posterior lumbar interbody fusion due to lumbar degenerative diseases in the Affiliated Changzhou Second People's Hospital of Nanjing Medical University and Affiliated Drum Tower Hospital,Medical School of Nanjing University from January 2009 to January 2019 were retrospectively analyzed.There were 102 males and 132 females,aged 60.1±10.0 years(range,41-78 years).The patients were divided into ASD group and non-ASD group according to whether ASD occurred after operation.The general data,pelvic incidence(PI),sacral slope(SS),pelvic tilt(PT),lumbar lordosis(LL),distal lordosis(DL),segmental lordosis(SL),lordosis distribution index(LDI)and sagittal vertical axis(SVA)before and after operation were compared between the two groups.Independent risk factors for the occurrence of ASD after lumbar fusion were analyzed using binary logistic regression.The receiver operating characteristic curve(ROC)was plotted,and the area under the curve was calculated for each independent risk factor.Results All patients successfully completed the operation and were followed up for 70.6±11.9 months(range,60-121 months).Among the 234 patients,116 patients developed ASD after operation.Age(t=2.697,P=0.008),fusion segment(χ2=16.439,P<0.001),preoperative PT(t=2.268,P=0.024),preoperative LL(t=2.042,P=0.042),preoperative DL(t=2.724,P=0.007),postoperative DL(t=3.104,P=0.002),postoperative LDI(t=2.063,P=0.040)and the difference of SVA before and after operation(Z=2.001,P=0.045)were statistically significant.Binary logistic regression analysis showed that LDI decreased(OR=0.971,P=0.002),two-level fusion(OR=3.477,P<0.001),and increased SVA difference before and after operation(OR=0.992,P=0.039)were independent risk factors for ASD after lumbar fusion.The ROC curve showed that the area under the curve and 95%CI of the nu

关 键 词：腰椎 脊柱融合术 放射学 危险因素 

分 类 号：R687.3[医药卫生—骨科学]