血清骨代谢联合MRI椎体骨质量评分预测后路腰椎椎体间融合失败风险的研究  

Bone Turnover Markers Combined with MRI Vertebral Bone Quality in the Prediction of Pseudoarthrosis of Posterior Lumbar Intervertebral Fusion

作　　者：冯焘[1] 王金宁[1] 钮俊杰 杨炎[1] 金盛阳 FENG Tao;WANG Jin-ning;NIU Jun-jie;YANG Yan;JIN Sheng-yang(Department of Orthopeadics Surgery,First Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215006,China)

机构地区：[1]苏州大学附属第一医院骨科,江苏苏州215006

出　　处：《中国血液流变学杂志》2024年第4期567-571,共5页Chinese Journal of Hemorheology

基　　金：苏州市基础研究试点项目(SSD2024048)。

摘　　要：目的探讨将血清骨代谢指标与腰椎骨质量(VBQ)联合用于预测后路腰椎椎体间融合失败发生的可行性。方法回顾性分析2021年10月—2023年10月55岁以上术前完善骨代谢检测的单节段后入路腰椎椎体间融合术患者60例,统计患者一般资料,骨代谢指标(CROSSL、TPINP)情况,通过术前腰椎MRI数据计算VBQ。根据术后1年随访时X线片结果判断手术节段是否融合,将病例分为融合组及非融合组。采用独立样本t检验、卡方检验的方法对数据进行分析。采用二元Logistic回归对腰椎椎体间融合失败的危险因素进行分析。结果60例患者中共有23例患者未融合。融合组与非融合组在包括年龄、性别、饮酒、手术融合节段等在内的一般资料中的比较差异无统计学意义。末次随访时非融合组VAS评分显著高于融合组[(3.91±0.67)vs(1.65±0.75)]。非融合组患者的血清骨代谢指标中破骨指标升高比例显著高于融合组,而成骨指标两者分布差异无统计学意义。非融合组的VBQ值[(3.20±0.48)vs(2.34±0.30)]、BMI指数[(26.70±2.89)vs(23.01±2.41)]显著高于融合组,且其糖尿病患病率、吸烟率显著高于融合组。通过二元Logistic回归对上述因素分析后发现高VBQ值及血清骨代谢指标中破骨指标升高是术后发现不融合的独立危险因素。结论导致腰椎椎体间融合失败的危险因素较多,术前血清骨代谢检测提示破骨指标升高及腰椎VBQ评分高有助于预测术后发生不融合及早期进行针对性干预。Objective To investigate the feasibility of utilizing serum bone turnover markers in conjunction with lumbar vertebral bone quality(VBQ)for predicting the occurrence of postoperative pseudoarthrosis of lumbar intervertebral fusion.Methods A retrospective study was performed on 60 patients,aged 55 and above,who underwent single-level posterior lumbar interbody fusion surgery between October 2021 and October 2023,with comprehensive preoperative blood bone turnover assessments.Patient demographics,bone metabolism markers(CROSSL,TPINP),and lumbar VBQ scores derived from preoperative lumbar MRI scans were documented.The fusion status of the surgical level was evaluated using X-ray images obtained during the one-year postoperative follow-up,and patients were subsequently categorized into fused and non-fused groups.Statistical analyses were conducted using independent sample t-tests andχ2 tests.Additionally,binary logistic regression was employed to identify risk factors for pseudoarthrosis of lumbar intervertebral fusion.Results Of the 60 patients,23 presented pseudoarthrosis.There were no statistically significant differences between the fused and non-fused groups in terms of age,gender,alcohol consumption,and surgical fusion level.At the final follow-up,the VAS score was significantly higher in the non-fused group compared to the fused group[(3.91±0.67)vs(1.65±0.75)].The proportion of elevated bone resorption markers was significantly higher in the non-fused group than in the fused group,while there was no significant difference in the distribution of bone formation markers between the two groups.The non-fused group had significantly higher VBQ values[(3.20±0.48)vs(2.34±0.30)],BMI indices[(26.70±2.89)vs(23.01±2.41)],diabetes prevalence,and number of smokers compared to the fused group.Binary logistic regression analysis revealed that higher VBQ score and elevated bone resorption marker were independent risk factors for predicting postoperative fusion failure.Conclusion There are multiple risk factors contribut

关 键 词：骨代谢 骨质量评分 后路腰椎椎体间融合 融合失败 

分 类 号：R681.53[医药卫生—骨科学]