不同年龄腰椎间盘突出症患者术前脊柱-骨盆矢状位序列与单侧双通道脊柱内镜下手术后复发的关系

The relationship between preoperative spinal-pelvic sagittal sequence and postoperative recurrence after unilateral biportal endoscopic spinal surgery in patients with lumbar disc herniation of different ages

中文关键词:  腰椎间盘突出症  单侧双通道脊柱内镜手术  脊柱-骨盆矢状位序列  复发

英文关键词:Lumbar disc herniation  Unilateral biportal endoscopic spinal surgery  Spinal-pelvic sagittal sequence  Recurrence

中文摘要:

  【摘要】　目的：探讨不同年龄腰椎间盘突出症患者术前脊柱-骨盆矢状位序列与单侧双通道脊柱内镜（unilateral biportal endoscopic spinal surgery,UBE）下手术后复发的关系。方法：选择2018年12月~2022年10月于我院行UBE下手术治疗的腰椎间盘突出症患者200例为研究对象，男120例，女80例；年龄19~67岁（46.3±6.9岁）。按年龄分为两组：年龄<45岁者94例，纳入青壮年组；年龄≥45岁者106例，纳入中老年组。在术前全脊柱侧位X线片上测量脊柱-骨盆矢状位序列参数，包括胸椎后凸角（thoracic kyphosis，TK）、骨盆入射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt，PT）、腰椎前凸角（lumbar lordosis，LL）和骶骨倾斜角（sacral slope，SS），采用Pearson相关分析患者脊柱-骨盆矢状位参数与年龄的关系。患者出院后进行2年的随访，依据随访期是否复发分为复发组（n=33）和未复发组（n=167），采用多因素Logistic回归分析复发的影响因素。应用受试者操作特性曲线（receiver operating characteristic curve，ROC）评估脊柱-骨盆矢状位参数对复发的预测价值；确定ROC曲线下面积（the area under the ROC curve, AUC），并计算95%置信区间（confidence interval，CI）。结果：中老年组的LL、PI、PT、SS均低于青壮年组（t=5.960、2.163、2.245、2.296，P均<0.05），Pearson分析显示，LL、PI、PT、SS与年龄之间均存在负相关关系（r=-0.67、-0.72、-0.65、-0.63，P均<0.001）。复发组年龄≥45岁、纤维环破口>5mm人数占比高于未复发组，LL、PI、SS均低于未复发组（P<0.05）。多因素Logistic回归分析显示，年龄≥45岁是复发的独立危险因素（OR=2.694，95%CI：2.231~2.945，P<0.05），LL升高（OR=0.623，95%CI：0.435~0.895，P<0.05）、SS升高是复发的保护因素（OR=0.687，95%CI：0.412~0.738，P<0.05）。ROC曲线分析结果显示，LL、SS预测患者复发的AUC分别为0.743（95%CI：0.670~0.856）、0.754（95%CI：0.669~0.872），两项联合预测患者复发的AUC为0.852（95%CI: 0.769~0.903）。结论：脊柱-骨盆矢状位序列参数与年龄及术后复发风险密切相关，年龄≥45岁是术后复发的独立危险因素，而较高的LL与SS则为保护性因素。术前评估脊柱-骨盆矢状位序列，尤其是LL与SS，有助于识别UBE术后复发高风险人群，为个体化手术策略提供重要参考。

英文摘要:

  【Abstract】 Objectives: To explore the relationship between preoperative spinal-pelvic sagittal sequence and postoperative recurrence after unilateral biportal endoscopic(UBE) spinal surgery in patients with lumbar disc herniation of different ages. Methods: 200 patients with lumbar disc herniation who underwent UBE surgery in our hospital from December 2018 to October 2022 were selected as the study subjects. They were divided into two groups according to ages: 94 patients under 45 years old were included in the young and middle-aged group, and 106 patients at 45 years old and over were included in the middle-aged and elderly group. The spinal-pelvic sagittal sequence parameters, including thoracic kyphosis(TK), pelvic incidence(PI), pelvic tilt(PT), lumbar lordosis(LL), sacral slope(SS), were measured on preoperative lateral X-ray films of the entire spine. The relationship between spinal-pelvic sagittal parameters and age was studied using Pearson analysis. After discharge, the patients were followed up for 2 years and divided into a recurrent group(n=33) and a non-recurrent group(n=167) based on the recurrence condition during the follow-up period. Multivariate logistic regression analysis was conducted to identify the influencing factors of recurrence. The receiver operating characteristic curve(ROC) was adopted to evaluate the predictive value of spinal-pelvic sagittal parameters for recurrence; And the area under the ROC curve(AUC) was determined, and the 95% confidence interval(CI) was calculated. Results: The LL, PI, PT, and SS of the middle-aged and elderly group were lower than those of the young and middle-aged group(t=5.960, 2.163, 2.245, 2.296, P<0.05). Pearson analysis showed that LL, PI, PT, and SS were negatively correlated with age(r=-0.67, -0.72, -0.65, -0.63, P<0.001). The proportion of patients aged ≥45 years and with a annulus fibrosus rupture >5mm in the recurrent group was higher than that in the non-recurrent group, while LL, PI, and SS were lower than those in the non-recurrent group(P<0.05). Multivariate logistic regression analysis showed that age ≥45 years old was an independent risk factor for recurrence(OR=2.694, 95%CI: 2.231-2.945, P<0.05), while elevated LL(OR=0.623, 95%CI: 0.435-0.895, P<0.05) and elevated SS were protective factors for recurrence(OR=0.687, 95%CI: 0.412-0.738, P<0.05). The ROC curve results showed that the AUC for predicting patient recurrence using LL and SS were 0.743(95%CI: 0.670-0.856) and 0.754(95%CI: 0.669-0.872), respectively. The AUC for predicting patient recurrence using both methods was 0.852(95%CI: 0.769-0.903). Conclusions: The parameters of the spinal-pelvic sagittal sequence are closely related to age and postoperative recurrence risk. Age ≥45 years is an independent risk factor for postoperative recurrence, while higher LL and SS are protective factors. Preoperative evaluation of spinal-pelvic sagittal sequence, especially LL and SS, can help identify high-risk populations for UBE postoperative recurrence and provide important references for individualized surgical strategies.