椎体CT参数对TLIF术后早期融合器沉降的预测价值  

Predictive value of vertebral CT parameters for early fusion sink after TLIF

作　　者：李小硕[1] 韩子旭 李洋 李梦宁 LI Xiaoshuo;HAN Zixu;LI Yang;LI Mengning(Department of Imaging,Tangshan No.2 Hospital,Tangshan 063000,China;Department of Radiology,Tangshan No.2 Hospital,Tangshan 063000,China;Department of MRI,Kailuan General Hospital,Tangshan)

机构地区：[1]唐山市第二医院影像科,063000 [2]唐山市第二医院放射科,063000 [3]唐山市开滦总医院磁共振室

出　　处：《天津医药》2025年第3期301-306,共6页Tianjin Medical Journal

基　　金：河北省医学科学研究课题计划(20251182)。

摘　　要：目的探讨椎体CT参数对经椎间孔腰椎椎体间融合术(TLIF)术后早期融合器沉降的预测价值。方法选取178例经TLIF手术治疗的腰椎退行性病变患者的临床及影像学资料,根据患者术后3个月融合器沉降情况分为沉降组(n=57)及无沉降组(n=121),比较两组一般资料及CT影像参数结果,采用多因素Logistic回归分析早期融合器沉降的危险因素,并进行预测效能分析。结果早期融合器沉降发生率为32.0%。与无沉降组比较,沉降组年龄≥60岁、骨质疏松症、手术节段L_(5)—S_(1)占比及椎间隙高度较高,融合器接触面积、节段性前凸角较大,腰椎CT值较低(P<0.05);Logistic回归分析显示,年龄≥60岁、手术节段L_(5)—S_(1)、椎间隙高度高、节段性前凸角大是融合器沉降的独立危险因素,腰椎CT值偏高则是保护因素(P<0.05);受试者工作特征曲线显示,腰椎CT值、椎间隙高度、节段性前凸角联合预测TLIF术后早期融合器沉降的曲线下面积(AUC)高于年龄≥60岁、手术节段L_(5)—S_(1)、腰椎CT值、椎间隙高度、节段性前凸角单独应用(P<0.05)。结论椎体CT参数腰椎CT值、椎间隙高度和节段性前凸角对TLIF术后早期融合器沉降的预测价值较高,且3个参数联合的预测价值更高。Objective To investigate the prognostic value of vertebral CT parameters for early fusion sink after transforaminal lumbar interbody fusion(TLIF).Methods The clinical and imaging data of 178 patients with lumbar degenerative diseases treated by TLIF were retrospectively studied.The patients were divided into the sedimentation group(n=57)and the non-sedimentation(n=57)group according to the patient′s fusion device settlement 3 months after surgery.The results of general data and CT image parameters were compared between the two groups.Multivariate Logistic regression was used to analyze risk factors of early fusion subsidence,and the prediction efficiency was analyzed.Results The incidence of the early fusion sink was 32.0%.Compared with the non-sedimentation group,the sedimentation group had a higher proportion of patients aged≥60 years,osteoporosis,L_(5)-S_(1) and intervertebral space height,larger fusion contact area and segmental lordosis angle and lower lumbar CT value(P<0.05).Logistic regression analysis showed that age≥60 years old,surgical level L_(5)-S_(1),high intervertebral height and large segmental lordosis angle were independent risk factors for the early fusion after TLIF,while high lumbar CT value was protective factor(P<0.05).Subject working characteristic curves showed that the area under the curve(AUC)of lumbar CT value,intervertebral height,segmental lordosis angle combined with AUC were higher than those of patients aged≥60 years,surgical segment L_(5)-S_(1),lumbar CT value,intervertebral height,segmental lordosis angle applied alone(P<0.05).Conclusion Vertebral CT parameters of lumbar CT value,intervertebral height and segmental lordosis angle have higher predictive value for the early fusion after TLIF,and the combined prediction value of the three parameters is higher.

关 键 词：椎间盘退行性变 椎体 体层摄影术 X线计算机 经椎间孔腰椎椎体间融合术 融合器沉降 

分 类 号：R681.5[医药卫生—骨科学]