极外侧入路腰椎椎体间融合术后早期相邻节段退变的发生情况及危险因素  

Occurrence and risk factors of adjacent segment degeneration after early extreme lateral interbody fusion

作　　者：郭扬 万文涛 边汉明 陈超[1] 杨海云[1] 赵栋[1] 杨强[1] Guo Yang;Wan Wentao;Bian Hanming;Chen Chao;Yang Haiyun;Zhao Dong;Yang Qiang(Department of Spinal Surgery,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院脊柱外科,天津300211

出　　处：《中华医学杂志》2025年第9期681-687,共7页National Medical Journal of China

基　　金：国家自然科学基金(82372419);天津市科技重大专项与工程“揭榜挂帅”重大项目(21ZXJBS00130);京津冀基础研究合作专项(J230020);国家重点研发计划科技型中小企业项目(2023YFC2416900)。

摘　　要：目的探讨极外侧入路腰椎椎体间融合术(XLIF)术后相邻节段退变(ASD)的发生情况,以及XLIF术后早期出现ASD的危险因素。方法回顾性纳入2019年7月至2022年12月于天津市天津医院行XLIF的腰椎管狭窄症、至少随访1年的患者。所有患者术前及末次随访时均完成腰椎MRI及X线检查,评估相邻节段的退变状态。根据患者末次随访时有无发生ASD,将患者分为无ASD组和ASD组。对两组患者的年龄、性别、体质指数(BMI)、麻醉美国麻醉医师协会(ASA)分级、随访时间、融合节段数量、手术时长、出血量、住院天数,术前及随访时期临床功能评分、疼痛视觉模拟评分(VAS)及矢状位参数、相邻节段的椎管形态分级和椎间盘Pfirrmann分级进行比较分析。将组间比较中P值<0.1的变量纳入多因素logistic回归模型,以探讨XLIF术后早期出现ASD的危险因素。结果共有68例患者纳入本研究,男20例,女48例,年龄(60.0±6.9)岁。末次随访时,20例(28.9%)发生ASD,纳入ASD组,余48例纳入无ASD组。两组患者的人口学特征差异均无统计学意义(均P>0.05),具有可比性。与ASD组相比,无ASD组术前腰椎前凸角(LL)(46.5°±12.0°比32.3°±15.9°,P<0.01)和骶骨倾斜角(SS)(36.6°±7.1°比29.5°±12.6°,P=0.022)均更大,术前骨盆入射角-腰椎前凸角(PI-LL)不匹配率更低[25.0%(12/48)比60.0%(12/20),P=0.033],术前相邻节段椎管形态分级更优(0级/1级分别为33/15例和6/14例,P<0.01)。与术前相比,两组末次随访时Oswestry功能障碍指数(ODI)评分、VAS(腰)和VAS(腿)均有明显改善(均P<0.01),且两组间术前临床功能评分及末次随访时临床功能改善率差异均无统计学意义(均P>0.05)。多因素logistic回归模型分析显示术前相邻节段椎管形态分级为1级是XLIF术后早期出现ASD的危险因素(OR=13.00,95%CI:2.51~67.04,P<0.01)。结论XLIF术后1年有28.9%的患者会发生ASD,术前相邻节段椎管形态分级为1级是XLIF术后早�Objectives To investigate the incidence of adjacent segment degeneration(ASD)following extreme lateral interbody fusion(XLIF)and identify risk factors for early ASD after XLIF.Methods A retrospective study was conducted,including patients diagnosed with lumbar spinal stenosis who underwent XLIF at Tianjin Hospital between July 2019 and December 2022 and were followed-up for at least one year.Preoperative and final follow-up lumbar MRI and X-ray examination were performed for all patients to evaluate the degeneration status of adjacent segments.According to the occurrence of ASD at the last follow-up,the patients were divided into non-ASD group and ASD group.Age,gender,age,body mass index(BMI),American Society of Anesthesiologists(ASA)grade of anesthesia,follow-up time,length of fusion,time of operation,blood loss,hospital stay,pre-operation and follow-up clinical effects scores,pre-operation and follow-up sagittal parameters,central canal stenosis grades of adjacent segment and Pfirrmann grades were analyzed and compared between the two groups.Variables with a P-value less than 0.1 in the intergroup comparisons were included in a multivariate regression analysis to identify the risk factors for early onset of ASD following XLIF.Results A total of 68 patients were included in this study,including 20 males and 48 females with a mean age of(60.0±6.9)years.At the last follow-up,20 cases(28.9%)developed ASD and were included in the ASD group,while the remaining 48 cases were included in the non-ASD group.There was no statistically significant differences in the demographic characteristics between the two groups of patients(all P>0.05),indicating comparability.Compared with those in ASD group,the preoperative lumbar lordosis angle(LL)(46.5°±12.0°vs 32.3°±15.9°,P<0.01)and the sacral slope angle(SS)(36.6°±7.1°vs 29.5°±12.6°,P=0.022)in the non-ASD group were both greater,the mismatch rate of the preoperative pelvic incidence-lumbar lordosis angle(PI-LL)was lower[25.0%(12/48)vs 60.0%(12/20),P=0.033],and the pr

关 键 词：椎管狭窄 极外侧入路腰椎椎体间融合术 相邻节段退变 椎管形态分级 矢状位平衡 

分 类 号：R68[医药卫生—骨科学]