单侧双通道内镜减压经皮椎弓根螺钉内固定治疗单节段腰椎椎管狭窄症术后螺钉松动的危险因素分析  

Risk factors of screw loosening after unilateral biportal endoscopy decompression and percutaneous pedicle screw fixation for single-segment lumbar spinal stenosis

作　　者：熊超[1] 毕亮 郑振阳 李继安 李建刚[1] Xiong Chao;Bi Liang;Zheng Zhenyang;Li Jian;Li Jiangang(Department of Orthopedics,Tianjin Fourth Central Hospital,Tianjin 300140,China)

机构地区：[1]天津市第四中心医院骨科,天津300140

出　　处：《中华骨科杂志》2025年第1期59-66,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨单侧双通道内镜(unilateral biportal endoscopic,UBE)减压经皮椎弓根螺钉内固定治疗单节段腰椎椎管狭窄症术后矢状位参数与螺钉松动的相关性。方法回顾性收集2020年6月至2023年6月180例于天津市第四中心医院骨科因单节段腰椎椎管狭窄症行UBE减压经皮椎弓根螺钉内固定治疗的患者资料。根据术后随访中椎弓根螺钉内固定系统是否出现松动分为未松动组(112例)和松动组(68例)。比较两组的基线资料、手术相关指标以及手术前后的矢状位参数[骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、腰椎前凸角(lumbar lordosis,LL)、胸椎后凸角(thoracic kyphosis,TK)、矢状面平衡(sagittal vertical axis,SVA)]。将两组比较差异有统计学意义的指标纳入二分类变量logistic回归分析螺钉松动的影响因素;限制性立方样条模型分析矢状位参数与螺钉松动的剂量反应关系。结果松动组术后半年、术后1年椎间融合率分别为47.1%、55.9%,小于未松动组的85.7%、100.0%,差异有统计学意义(P<0.05)。术后未松动组SS为36.16°±5.35°、松动组SS为32.02°±5.54°、松动组LL为51.26°±6.35°,均小于术前的40.51°±6.11°、40.49°±6.08°、54.08°±6.21°;未松动组PT为15.24°±2.69°、未松动组TK为32.46°±7.29°、松动组PI为56.82°±5.23°、松动组PT为17.01°±3.64°、松动组TK为34.87°±7.21°,均大于术前的13.12°±3.19°、30.25°±5.17°、52.84°±5.12°、13.15°±3.21°、30.26°±5.12°,差异有统计学意义(P<0.05)。术后松动组SS为32.02°±5.54°、LL为51.26°±6.35°、SVA为(-0.87±1.06)cm,小于未松动组的36.16°±5.35°、53.73°±6.27°、(-0.51±1.04)cm;松动组PI为56.82°±5.23°、PT为17.01°±3.64°、TK为34.87°±7.21°,均大于未松动组的53.48°±5.20°、15.24°±2.69°、32.46°±7.29°,差异有统计学意义(P<0.05)。二分类变量logistic回归分析示PT、SS、LL、SVA均�Objective To investigate the relationship between sagittal position parameters and screw loosening after unilateral biportal endoscopic(UBE)combined with percutaneous pedicle screw fixation for single-segment lumbar spinal stenosis.Methods A total of 180 patients with single-level lumbar spinal stenosis who received UBE combined with percutaneous pedicle screw internal fixation in our hospital from June 2020 to June 2023 were enrolled.According to the postoperative follow-up,they were divided into the non-loosening group(112 cases)and the loosening group(68 cases).The demographics,operative parameters and sagittal position[pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),lumbar lordosis(LL),thoracic kyphosis(TK),sagittal vertical axis(SVA)]before and after operation were compared between the two groups.The indicators with significant differences between the two groups were included in the multivariate logistic regression analysis to analyze the influencing factors of screw loosening.The dose-response relationship between sagittal position parameters and screw loosening was analyzed by restricted cubic spline model.Results At 6 months and 1 year postoperatively,the fusion rates in the loosening group were 47.1%and 55.9%,respectively,which were significantly lower than the rates(85.7%and 100.0%)in the non-loosening group,respectively(P<0.05).Postoperatively,the SS in the non-loosening group(36.16°±5.35°)and the loosening group(32.02°±5.54°)and the LL in the loosening group(51.26°±6.35°)were all significantly lower than preoperative values(40.51°±6.11°,40.49°±6.08°,and 54.08°±6.21°)(P<0.05).Meanwhile,the PT in the non-loosening group(15.24°±2.69°),TK in the non-loosening group(32.46°±7.29°),PI in the loosening group(56.82°±5.23°),PT in the loosening group(17.01°±3.64°),and TK in the loosening group(34.87°±7.21°)were all significantly higher than preoperative values(13.12°±3.19°,30.25°±5.17°,52.84°±5.12°,13.15°±3.21°,and 30.26°±5.12°)(P<0.05).Postoperatively,the lo

关 键 词：腰椎 椎管狭窄 椎弓根钉 单侧双通道内镜 

分 类 号：R687.3[医药卫生—骨科学]