年龄及融合术式与腰椎后路融合术后邻近节段退变性疾病再手术的关系
|
摘要
目的:探讨患者初次手术时年龄及融合术式与腰椎后路融合术后邻近节段退变性疾病再手术的关系。方法:从2013年3月～2017年3月在我院脊柱外科接受腰椎后路融合术治疗的患者中,选取腰椎后路融合术后发生邻近节段退变性疾病且再次进行手术治疗的113例患者作为再手术组,初次手术时年龄49～79岁(56.4±2.1岁),其中接受后路椎体间融合术(PLIF)67例,后外侧腰椎融合术(PLF)23例,经椎间孔椎体间融合术(TLIF)21例;随访时间9～42个月(24.6±1.1个月)。同时,匹配226例腰椎后路融合术后未发生邻近节段退变性疾病的患者作为对照组,初次手术时年龄46～82岁(57.1±1.1岁),其中接受PLIF 97例,PLF 45例,TLIF84例,随访时间为9～48个月(24.9±0.6个月)。对两组患者接受融合术前和末次随访时(2017年12月)进行腰痛VAS和腰椎JOA评分。应用卡方检验、t检验比较两组患者的初次手术时年龄、性别分布、婚姻情况、文化程度、体质指数(BMI)、融合术式、融合节段个数、椎板是否切除及是否悬浮固定的分布差异,利用Logistic回归分析初次手术时年龄及融合术式与腰椎后路融合术后邻近节段退变性疾病再手术的关系。结果:单因素分析结果显示,两组间性别分布、婚姻情况、文化程度、BMI的差异无统计学意义(P>0.05),但初次手术时年龄、融合术式、融合节段个数、椎板是否切除及是否悬浮固定的差异有统计学意义(P<0.05)。Logistic回归分析显示,两组患者的年龄分布差异有统计学意义,其OR值为1.23,95%CI为1.12～3.56;两组患者接受PLF、TLIF对比接受PLIF的分布的差异有统计学意义,其OR值及95%CI分别为0.76(0.34～0.89)、0.68(0.25～0.82)。调整融合术式、融合节段个数、椎板是否切除及是否悬浮固定等变量后,初次手术时年龄≥60岁对比<60岁的患者,a OR值为2.54,95%CI为1.23～3.56;调整年龄、融合节段个数、椎板是否切除及是否悬浮固定等变量后,接受PLF、TLIF的患者对比接受PLIF的患者,融合术后发生邻近节段退变性疾病需要再次手术的风险均明显降低,其a OR值及95%CI分别为0.54(0.42～0.77)、0.47(0.34～0.83)。再手术组和对照组末次随访时的腰痛VAS评分、腰椎JOA评分与术前比较均有统计学差异(P<0.05),且再手术组末次随访时腰痛VAS评分和腰椎JOA评分均优于对照组,差异有统计学意义(P<0.05)。结论:接受腰椎后路融合术治疗的患者年龄越大,术后发生邻近节段退变性疾病需要再次接受手术治疗的可能性也越大。同时,接受PILF比PLF、TLIF更可能导致术后邻近节段退变性疾病再手术。
Objectives: To explore the relationship between the age of patients or fusion choice and reoperation of adjacent segment disease(ASD) after posterior lumbar fusion. Methods: Clinical data of 339 patients who underwent posterior lumbar fusion between March 2007 and March 2017 were retrospectively analyzed. Reoperation group included 113 patients who received additional surgery for ASD and control group included 226 cases without ASD after the initial surgery. The original fusion choices for reoperation group were 67 of posterior lumbar interbody fusion(PLIF), 23 of posterior lumbar fusion(PLF) and 21 of transforaminal lumber interbody fusion(TLIF). For the control group, 97 received PLIF, 45 received PLF and84 received TLIF. The clinical outcomes were evaluated by the comparison of VAS score and lumbar JOA score between preoperation and the last follow-up. Results: The mean age was 56.4±2.1 years in reoperation group and 57.1±1.1 years in control group, and the mean follow-up period was 24.6±1.1 months in reoperation group and 24.9±0.6 months in control group. The VAS scores of lumbar pain and lumbar JOA score at the last follow-up in both reoperation group and control group were significantly lower than those of preoperation. Reoperation group showed significantly lower VAS and lumbar JOA score at the last follow-up compared with control group. Additionally, patients who were 60 or older at the initial surgery were more likely to suffer from ASD, and patients who received PLF and TLIF were less likely to be affected by ASD. Conclusions: It is concluded that higher age at the initial surgery and PLIF is more likely to result in ASD and reoperation.
Objectives: To explore the relationship between the age of patients or fusion choice and reoperation of adjacent segment disease(ASD) after posterior lumbar fusion. Methods: Clinical data of 339 patients who underwent posterior lumbar fusion between March 2007 and March 2017 were retrospectively analyzed. Reoperation group included 113 patients who received additional surgery for ASD and control group included 226 cases without ASD after the initial surgery. The original fusion choices for reoperation group were 67 of posterior lumbar interbody fusion(PLIF), 23 of posterior lumbar fusion(PLF) and 21 of transforaminal lumber interbody fusion(TLIF). For the control group, 97 received PLIF, 45 received PLF and84 received TLIF. The clinical outcomes were evaluated by the comparison of VAS score and lumbar JOA score between preoperation and the last follow-up. Results: The mean age was 56.4±2.1 years in reoperation group and 57.1±1.1 years in control group, and the mean follow-up period was 24.6±1.1 months in reoperation group and 24.9±0.6 months in control group. The VAS scores of lumbar pain and lumbar JOA score at the last follow-up in both reoperation group and control group were significantly lower than those of preoperation. Reoperation group showed significantly lower VAS and lumbar JOA score at the last follow-up compared with control group. Additionally, patients who were 60 or older at the initial surgery were more likely to suffer from ASD, and patients who received PLF and TLIF were less likely to be affected by ASD. Conclusions: It is concluded that higher age at the initial surgery and PLIF is more likely to result in ASD and reoperation.
引文
1. Deyo RA. Fusion surgery for lumbar degenerative disc disease:still more questions than answers[J]. Spine J, 2015, 15(2):272-274.
2 . Coric D, Guyer RD, Nunley PD, et al. Prospective, randomized multicenter study of cervical arthroplasty versus anterior cervical discectomy and fusion:5-year results with a metalon-metal artificial disc[J]. J Neurosurg Spine, 2018, 28(3):252-261.
3 .付海祥,曹兴兵,陈奇,等.腰椎间盘突出症融合术后邻近节段退变危险因素[J].中国矫形外科杂志, 2015, 23(13):1179-1182.
4 .马俊,席焱海,叶晓健.腰椎融合术后邻近节段退变再手术策略的研究进展[J].中国脊柱脊髓杂志, 2016, 26(11):1047-1050.
5 .曹华,陈步俊,祁伟,等. L_(4-5)融合术后邻近节段退变的回顾性分析[J].中国矫形外科杂志, 2017, 25(21):1954-1957.
6 .陈佳佳,龚沈初,保国锋,等.腰椎后路单节段固定融合术后邻近节段关节突关节退变的随访观察[J].中国脊柱脊髓杂志,2017, 27(10):883-888.
7 . Kim JY, Ryu DS, Paik HK, et al. Paraspinal muscle, facet joint, and disc problems:risk factors for adjacent segment degeneration after lumbar fusion[J]. Spine J, 2016, 16(7):867-875.
8 .焦海斌,胡学昱,黄培培,等. L4/5单节段融合对不同腰椎Roussouly分型腰椎骨盆矢状位参数和临床疗效的影响[J].中国脊柱脊髓杂志, 2015, 25(5):405-414.
9 .易伟林,梁斌,陈峰,等.腰椎融合术后早期下肢深静脉血栓形成的相关危险因素分析[J].中国脊柱脊髓杂志, 2017, 27(9):823-828.
10 . Ghasemi AA. Adjacent segment degeneration after posterior lumbar fusion:an analysis of possible risk factors[J]. Clin Neurol Neurosurg, 2016, 143:15-18.
11 .韩志伟,于秀淳,黄伟敏,等.杂交与融合手术治疗双节段腰椎退变性疾病的对比[J].中国矫形外科杂志, 2017, 25(13):1158-1163.
12 .张明凯,汤健,尤涛.下位节段椎间融合器融合、上位节段自体骨植骨融合治疗双节段退变性腰椎不稳临床观察[J].山东医药, 2017, 57(16):47-49.
13 .苗峰,姜复龄.氨酚羟考酮在腰椎后路融合术后的镇痛效果观察[J].中国药房, 2017, 28(11):1513-1515.
14 . Yoshihara H, Yoneoka D. National trends in the surgical treatment for lumbar degenerative disc disease:United States,2000 to 2009[J]. Spine J, 2015, 15(2):265-271.
15 .王朝君,冯艳红,张晓丽,等.腰椎内固定融合后L3/4节段邻近节段病变与性别的关系[J].中国组织工程研究, 2016,20(39):5813-5818.
16 . Wang H, Ma L, Yang D, et al. Incidence and risk factors of adjacent segment disease following posterior decompression and instrumented fusion for degenerative lumbar disorders[J].Medicine(Baltimore), 2017, 96(5):e6032.
17 . Matsumoto T, Okuda S, Maeno T, et al. Spinopelvic sagittal imbalance as a risk factor for adjacent-segment disease after single-segment posterior lumbar interbody fusion[J]. J Neurosurg Spine, 2017, 26(4):435-440.
18 . Lu K, Liliang PC, Wang HK, et al. Reduction in adjacentsegment degeneration after multilevel posterior lumbar interbody fusion with proximal DIAM implantation[J]. J Neurosurg Spine, 2015, 23(2):190-196.
19 .朱峰,顾驰江,王云,等.保留内固定与内固定移除对腰椎后路减压融合术后感染的影响研究[J].中华医院感染学杂志, 2017, 27(9):2080-2083.
20 . Kim HJ, Kang KT, Chun HJ, et al. The influence of intrinsic disc degeneration of the adjacent segments on its stress distribution after one-level lumbar fusion[J]. Eur Spine J,2015, 24(4):827-837.
2 . Coric D, Guyer RD, Nunley PD, et al. Prospective, randomized multicenter study of cervical arthroplasty versus anterior cervical discectomy and fusion:5-year results with a metalon-metal artificial disc[J]. J Neurosurg Spine, 2018, 28(3):252-261.
3 .付海祥,曹兴兵,陈奇,等.腰椎间盘突出症融合术后邻近节段退变危险因素[J].中国矫形外科杂志, 2015, 23(13):1179-1182.
4 .马俊,席焱海,叶晓健.腰椎融合术后邻近节段退变再手术策略的研究进展[J].中国脊柱脊髓杂志, 2016, 26(11):1047-1050.
5 .曹华,陈步俊,祁伟,等. L_(4-5)融合术后邻近节段退变的回顾性分析[J].中国矫形外科杂志, 2017, 25(21):1954-1957.
6 .陈佳佳,龚沈初,保国锋,等.腰椎后路单节段固定融合术后邻近节段关节突关节退变的随访观察[J].中国脊柱脊髓杂志,2017, 27(10):883-888.
7 . Kim JY, Ryu DS, Paik HK, et al. Paraspinal muscle, facet joint, and disc problems:risk factors for adjacent segment degeneration after lumbar fusion[J]. Spine J, 2016, 16(7):867-875.
8 .焦海斌,胡学昱,黄培培,等. L4/5单节段融合对不同腰椎Roussouly分型腰椎骨盆矢状位参数和临床疗效的影响[J].中国脊柱脊髓杂志, 2015, 25(5):405-414.
9 .易伟林,梁斌,陈峰,等.腰椎融合术后早期下肢深静脉血栓形成的相关危险因素分析[J].中国脊柱脊髓杂志, 2017, 27(9):823-828.
10 . Ghasemi AA. Adjacent segment degeneration after posterior lumbar fusion:an analysis of possible risk factors[J]. Clin Neurol Neurosurg, 2016, 143:15-18.
11 .韩志伟,于秀淳,黄伟敏,等.杂交与融合手术治疗双节段腰椎退变性疾病的对比[J].中国矫形外科杂志, 2017, 25(13):1158-1163.
12 .张明凯,汤健,尤涛.下位节段椎间融合器融合、上位节段自体骨植骨融合治疗双节段退变性腰椎不稳临床观察[J].山东医药, 2017, 57(16):47-49.
13 .苗峰,姜复龄.氨酚羟考酮在腰椎后路融合术后的镇痛效果观察[J].中国药房, 2017, 28(11):1513-1515.
14 . Yoshihara H, Yoneoka D. National trends in the surgical treatment for lumbar degenerative disc disease:United States,2000 to 2009[J]. Spine J, 2015, 15(2):265-271.
15 .王朝君,冯艳红,张晓丽,等.腰椎内固定融合后L3/4节段邻近节段病变与性别的关系[J].中国组织工程研究, 2016,20(39):5813-5818.
16 . Wang H, Ma L, Yang D, et al. Incidence and risk factors of adjacent segment disease following posterior decompression and instrumented fusion for degenerative lumbar disorders[J].Medicine(Baltimore), 2017, 96(5):e6032.
17 . Matsumoto T, Okuda S, Maeno T, et al. Spinopelvic sagittal imbalance as a risk factor for adjacent-segment disease after single-segment posterior lumbar interbody fusion[J]. J Neurosurg Spine, 2017, 26(4):435-440.
18 . Lu K, Liliang PC, Wang HK, et al. Reduction in adjacentsegment degeneration after multilevel posterior lumbar interbody fusion with proximal DIAM implantation[J]. J Neurosurg Spine, 2015, 23(2):190-196.
19 .朱峰,顾驰江,王云,等.保留内固定与内固定移除对腰椎后路减压融合术后感染的影响研究[J].中华医院感染学杂志, 2017, 27(9):2080-2083.
20 . Kim HJ, Kang KT, Chun HJ, et al. The influence of intrinsic disc degeneration of the adjacent segments on its stress distribution after one-level lumbar fusion[J]. Eur Spine J,2015, 24(4):827-837.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |