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

Relationship between age or fusion choice and reoperation of adjacent segment disease after posterior lumbar fusion

中文关键词:  腰椎后路融合术  邻近节段退变性疾病  再手术  年龄  融合术式

英文关键词:Posterior lumbar fusion  Adjacent segment disease  Reoperation  Age  Methods of fusion

中文摘要:

  【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，TLIF 84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，aOR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aOR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。

英文摘要:

  【Abstract】 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 and 84 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.