腰椎邻近节段退行性疾病行延长融合节段翻修手术后置入物相关并发症的危险因素  

Risk factors for implant-related complications after revision surgery with extended fusion segments for lumbar adjacent segment degenerative disease

作　　者：曹飞 姚佩恒 苗晋军 唐祝涛 Cao Fei;Yao Peiheng;Miao Jinjun;Tang Zhutao(Department of Orthopaedics,Henan Rongjun Hospital,Xinxiang 453003,Henan,China)

机构地区：[1]河南省荣军医院骨科,新乡453003

出　　处：《脊柱外科杂志》2025年第1期35-39,共5页Journal of Spinal Surgery

摘　　要：目的分析腰椎邻近节段退行性疾病(ASDis)行延长融合节段翻修手术后置入物相关并发症的危险因素。方法回顾性分析2020年1月—2022年5月采用延长融合节段翻修手术治疗的65例ASDis患者临床资料,根据术后是否发生置入物相关并发症分为并发症组(n=13)和无并发症组(n=52)。采用单因素分析和多因素logistic回归分析筛选术后置入物相关并发症的潜在危险因素。结果单因素分析结果显示,2组术后腰椎前凸角(LL)、术后矢状垂直轴(SVA)、PI-LL<10°比例、手术前后T1骨盆角(TPA)变化值、初次手术置入物移除比例和初次手术行L_(5)/S_(1)节段内固定比例共6个指标差异均有统计学意义(P<0.05);多因素logistic回归分析结果显示,移除初次手术置入物(OR=4.835)、初次手术行L_(5)/S_(1)节段内固定[比值比(OR)=2.832]、术后矢状面失衡(OR=1.960)是ASDis患者翻修术后发生置入物相关并发症的独立危险因素。结论移除初次手术置入物是ASDis翻修术后发生置入物相关并发症的独立危险因素,临床在拟行ASDis翻修手术前应审慎考虑是否将初次手术的置入物予以移除。Objective To analyze the risk factors for implant-related complications after revision surgery with extended fusion segments for lumbar adjacent segment degenerative disease(ASDis).Methods A retrospective analysis was conducted on the clinical data of 65 patients with ASDis who underwent revision surgery with extended fusion segments from January 2020 to May 2022.The patients were divided into the complication group(n=13)and the non-complication group(n=52)based on whether there were any implant related complications after surgery.Univariate analysis and multiple logistic regression analysis were used to screen potential risk factors for postoperative implant-related complications.Results The univariate analysis showed that there were statistically significant differences between the 2 groups in 6 indicators,including postoperative lumbar lordosis(LL),postoperative sagittal vertical axis(SVA),the proportion of PI-LL<10°,T1 pelvic angle(TPA)change after surgery,the proportion of initial implant removal,and the proportion of initial L_(5)/S_(1)segment internal fixation(P<0.05).The multiple logistic regression analysis showed that initial implant removal(OR=4.835),initial L_(5)/S_(1)segment internal fixation(Odds ratio[OR]=2.832),and postoperative sagittal plane imbalance(OR=1.960)were independent risk factors for implant-related complications in ASDis patients undergoing revision surgery.Conclusions Removing the initial implant is an independent risk factor for implant-related complications after ASDis revision surgery.Clinically,careful consideration should be given to whether to remove the initial implant before planning for ASDis revision surgery.

关 键 词：腰椎 脊柱融合术 椎间盘退行性变 手术后并发症 再手术 

分 类 号：R681.533[医药卫生—骨科学]