腰椎后路融合术后发生不融合的风险因素研究  

Study on risk factors of nonunion after posterior lumbar fusion

作　　者：李陈 陈廷 于祁 孙光菊 LI Chen;CHEN Ting;YU Qi;SUN Guangju(Department of Orthopaedics,The First Affiliated Hospital of Anhui University of Technology,Huainan Anhui 232001,China)

机构地区：[1]安徽理工大学第一附属医院骨科,安徽淮南232001

出　　处：《蚌埠医学院学报》2024年第9期1174-1178,共5页Journal of Bengbu Medical College

基　　金：安徽省淮南市科技局项目(2021194)。

摘　　要：目的:探讨腰椎后路椎间植骨融合术后发生骨不融合的风险因素。方法:回顾性分析接受腰椎后路椎间融合治疗病人218例临床资料,术后随访1年。根据随访动态X线片结果将病人分为植骨不融合组(不融合组)25例和植骨融合组(融合组)193例。收集病人腰骶融合、融合节段数、手术方式、多裂肌及竖脊肌脂肪率、骨密度等相关指标,进行单因素分析和多因素logistic回归分析,并针对融合节段数进行亚组分析,采用ROC曲线确定高风险临界点。结果:单因素分析显示,融合节段数、腰骶融合情况、多裂肌脂肪浸润率和术前骨密度在2组间差异均有统计学意义(P<0.05);多因素logistic分析显示,腰骶融合、多节段融合、多裂肌高脂肪浸润率和术前骨密度均为腰椎融合术后植骨不融合的独立危险因素(P<0.05~P<0.01)。亚组分析显示,多裂肌脂肪浸润率、骨密度均为单节段融合病人植骨不融合的独立影响因素(P<0.01和P<0.05);融合节段数、腰骶融合、多裂肌脂肪浸润率和骨密度均为多节段融合病人植骨不融合的独立影响因素(P<0.05)。ROC曲线分析显示,多裂肌脂肪浸润率>22.75%、骨密度低于-0.85时发生椎间植骨不融合风险更高。结论:术前多裂肌脂肪浸润及病人骨质疏松情况与腰椎后路椎间融合术后骨融合密切相关,临床上应予以关注,尤其是对需要长节段腰骶融合的病人。Objective:To investigate the risk factors of bone nonunion after posterior lumbar interbody fusion.Methods:The case data of 218 patients who received posterior lumbar interbody fusion and followed up for one year were retrospectively analyzed.The patients were divided into bone graft nonunion group(n=25)and bone graft fusion group(n=193)according to dynamic X-ray.The lumbosacral fusion,number of fusion segments,operation mode,fat rate of multifidus and erector spinalis,and bone mineral density of patients were collected for univariate analysis and multivariate logistic regression analysis.Subgroup analysis was performed on the number of fusion segments.The ROC curve was used to determine the high-risk cutoff point.Results:Univariate analysis showed that there were differences in the number of fusion segments,lumbosacral fusion,fat infiltration rate of multifidus muscle and preoperative bone density between the two groups(P<0.05).Multivariate logistic analysis showed that lumbosacral fusion,multi-segmental fusion,high fat infiltration rate of multifidus muscle and preoperative bone mineral density were independent risk factors for nonunion of bone graft after lumbar fusion(P<0.05 to P<0.01).Subgroup analysis showed that the fat infiltration rate and bone mineral density were the independent factors for bone graft nonunion patients with single segment fusion(P<0.05),and the number of fusion segments,lumbosacral fusion,fat infiltration rate of multifidus muscle and bone mineral density were the independent factor for bone graft nonunion patients in multi segment fusion(P<0.05).ROC curve andysis showed that when fat infiltration rate of multifidus muscle was more than 22.75%and bone mineral density was less than-0.85,the risk of nonunion of intervertebral bone graft was higher.Conclusions:Preoperative fat infiltration of multifidus muscle and osteoporosis are closely related to bone fusion after posterior lumbar interbody fusion.Orthopedic doctors should pay attention to the above situations,especially for patients w

关 键 词：腰椎后路椎间植骨融合术 椎间植骨不融合 脂肪浸润 椎旁肌 骨质疏松 

分 类 号：R687.3[医药卫生—骨科学]