椎体骨质量及椎旁肌变化与经椎间孔腰椎椎间融合术后邻近节段退变的相关性研究  

Correlation of Vertebral Bone Quality and Paraspinal Muscle Changes With Adjacent Segment Degeneration After Transforaminal Lumbar Interbody Fusion Operation

作　　者：郑俊勇 王松 张鑫 肖萧 彭松林[1,4] ZHENG Junyong;WANG Song;ZHANG Xin;XIAO Xiao;PENG Songlin(The Second Clinical Medical College,Jinan University,Shenzhen 518020,China;The First Affiliated Hospital of Jinan University,Guangzhou 510632,China;Department of Orthopedic Surgery,Puning People's Hospital,Puning 515300,China;Department of Spine Surgery,Shenzhen People's Hospital,Shenzhen 518020,China)

机构地区：[1]暨南大学第二临床医学院,深圳518020 [2]暨南大学第一临床医学院,广州510632 [3]普宁市人民医院骨科,普宁515300 [4]深圳市人民医院脊柱外科,深圳518020

出　　处：《四川大学学报（医学版）》2024年第5期1301-1308,共8页Journal of Sichuan University(Medical Sciences)

基　　金：国家自然科学基金(No.82272488)资助。

摘　　要：目的通过回顾性分析因腰椎退行性疾病(lumbar degenerative disease,LDD)行经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)的患者,探讨椎体骨质量(vertebral bone quality,VBQ)及椎旁肌变化与TLIF术后邻近节段退变(adjacent segment degeneration,ASD)的相关性。方法选取2016年1月–2022年12月在深圳市人民医院因LDD行TLIF手术治疗并具有完善的随访影像学资料的患者共98例,根据ASD判定标准,分为ASD组43例,N-ASD组55例,收集两组患者的基本特征,并通过术前及末次随访时的腰椎核磁共振成像测量相关参数,包括VBQ,腰大肌(psoas major,PM)、竖脊肌(erector spinae,ES)及多裂肌(multifidus,MF)的总横截面积(total cross-section area,TCSA)、功能横截面积(functional cross-section area,FCSA),计算得出相对脂肪浸润(relative fat infiltration,RFI)。运用logistic回归分析研究ASD发生的危险因素。结果末次随访时ASD发生率为43.9%(43例),平均随访时间为(27.23±4.15)个月,两组的年龄,体质量指数(body mass index,BMI),术前骨密度(bone mineral density,BMD),术前VBQ、ΔRFIPM、ΔRFIES+MF的差异有统计学意义(P<0.05)。logistic回归分析结果显示BMI[比值比(odds ratio,OR)=1.450,95%置信区间(confidence interval,CI):1.081~1.945,P=0.013]、术前VBQ(OR=6.191,95%CI:1.692~22.657,P=0.006)、ΔRFIES+MF(OR=1.117,95%CI:1.007~1.238,P=0.037)为TLIF术后发生ASD的独立危险因素。结论因LDD行TLIF的患者术后ASD与较高的BMI、术前VBQ和术后竖脊肌与多裂肌的相对脂肪浸润程度增加相关。因此,强调在手术过程中对椎旁肌群的保护至关重要,并且术后加强腰背部肌肉锻炼,优化骨质量和体质量管理,有利于降低术后ASD的发生风险。Objective To investigate the correlation of vertebral bone quality(VBQ)and paraspinal muscle changes with adjacent segment degeneration(ASD)after transforaminal lumbar interbody fusion(TLIF)through a retrospective analysis of patients who have undergone TLIF for lumbar degenerative diseases(LDD).Methods A total of 98 patients who underwent TLIF surgical treatment for LDD between January 2016 and December 2022 at Shenzhen People's Hospital were selected.Well-established follow-up imaging data were available for all subjects who were divided into two groups,the ASD group(n=43)and the non-ASD(N-ASD)group(n=55),according to whether they met the ASD evaluation criteria.Data on the basic characteristics of the patients in both groups were collected,and the relevant parameters,including VBQ and the total cross-sectional area(TCSA)and the functional cross-sectional area(FCSA)of psoas major(PM),erector spinae(ES),and multifidus(MF),were measured by magnetic resonance imaging of the lumbar spine performed preoperatively and at the last follow-up.Then,the relative fat infiltration(RFI)was calculated from the above metrics accordingly.Logistic regression analysis was conducted to investigate the risk factors for ASD.Results The incidence of ASD was 43.9%(n=43)at the final follow-up.The mean follow-up time was(27.23±4.15)months.The age,body mass index(BMI),preoperative bone mineral density(BMD),preoperative VBQ,ΔRFIPM,andΔRFIES+MF showed significant differences between the ASD and N-ASD groups(P<0.05).According to the results of the logistic regression analysis,BMI(odds ratio[OR]=1.450,95%confidence interval[CI]:1.081-1.945,P=0.013),preoperative VBQ(OR=6.191,95%CI:1.692-22.657,P=0.006),andΔRFIES+MF(OR=1.117,95%CI:1.007-1.238,P=0.037)were independent risk factors for ASD.Conclusion The incidence of postoperative ASD in patients who have undergone TLIF for LDD was found to be associated with higher BMI,preoperative VBQ,and increased postoperative relative fat infiltration of the ES and MF muscles.Consequently,it is advisabl

关 键 词：腰椎椎间融合术 椎间盘退行性变 椎体骨质量 椎旁肌 

分 类 号：R687.3[医药卫生—骨科学]