椎旁肌退变及术后Roussouly分型恢复对女性退变性脊柱侧凸患者术后力学并发症的影响

Influence of paraspinal muscle degeneration and postoperative Roussouly classification restoration on mechanical complications in female patients with degenerative scoliosis after surgery

目的探讨女性退变性脊柱侧凸(DS)患者腰椎椎旁肌退变程度、术后未恢复理想Roussouly分型对后路长节段脊柱矫形术后力学并发症(MC)发生的影响。方法回顾性分析2017年6月至2021年11月于鼓楼医院接受长节段脊柱矫形的72例女性DS患者的临床资料。根据患者手术后矢状面是否恢复至理想的Roussouly分型进行分组,即术后矢状面恢复至理想Roussouly分型的患者为R组(n=51),未恢复则为N组(n=21)。根据术后2年内是否发生MC分为MC组(n=24)和NMC组(n=48)。R组中发生MC的为RM组(n=14),未发生为RN组(n=37);N组中发生MC的为NM组(n=10),未发生为NN组(n=11)。影像学评估包括脊柱及骨盆矢状面参数、各腰椎间盘平面的标准化椎旁肌横截面积(SCSA)和脂肪浸润率(FI%)。采用多因素logistic二元回归模型分析DS患者术后发生MC的危险因素。结果DS患者年龄(61.4±6.2)岁。DS患者MC的发生率为33.33%(24例)。R组中患者MC发生率为27.45%(14例),N组中患者MC发生率为47.62%(10例)。MC组患者术中骨盆倾斜角(PT)(-11.62°±10.06°比-7.04°±8.45°,P=0.046)与T1骨盆角(TPA)(-12.88°±11.23°比-7.31°±9.55°,P=0.031)的矫正量高于NMC组患者;在R组中发生术后MC的患者各腰椎节段椎旁肌FI%均高于未发生MC患者组(均P<0.05)。在R和N组中,术后发生MC的患者与未发生MC的患者相比各节段腰椎椎旁肌SCSA差异均无统计学意义(均P>0.05)。多因素logistic二元回归模型分析显示:腰椎椎旁肌平均FI%与DS患者脊柱矫形术后MC的发生相关,腰椎椎旁肌平均FI%≥22.63%为女性DS患者术后发生MC的危险因素(P=0.010,OR=1.088,95%CI:1.020~1.160)。结论术前椎旁肌退变程度较高的女性DS患者术后MC的发生率更高,针对此类患者,即使在术后恢复了理想的Roussouly分型,术后仍然面临着较高的MC风险。

Objective To investigate the impact of lumbar paraspinal muscle degeneration and postoperative failure to restore ideal Roussouly classification on the occurrence of mechanical complications(MC)following long-segment spinal correction surgery in female patients with degenerative scoliosis(DS).Methods The clinical data of 72 female DS patients who underwent long-segment spinal correction surgery in Gulou Hospital from June 2017 to November 2021 were retrospectively analyzed.According to whether restoring the ideal Roussouly classification after surgery,the patients were divided into R group(recovery group)(n=51)and N group(non-recovery group)(n=21).According to whether mechanical complications occurred after operation within two years,the patients were divided into MC(mechanical complications)group(n=24)and NMC(non-mechanical complications)group(n=48).The RM group(n=14)experienced mechanical complications in the R group,while the RN group(n=37)did not.The NM group(n=10)experienced mechanical complications in the N group,while the NN group(n=11)did not.Radiographic assessment included Sagittal parameters of spine and pelvis,standardized cross-sectional area(SCSA)and fat infiltration rate(FI%)of paraspinal muscle at each lumbar disc level.Results The age of DS patients in this study was(61.4±6.2)years.The incidence of MC was 33.33%(n=24)in all patients.The incidence of MC was 27.45%(n=14)in group R and 47.62%(n=10)in group N.The correction amount of pelvic tilt angle(PT)(-11.62°±10.06°vs-7.04°±8.45°,P=0.046)and T1 pelvic angle(TPA)(-12.88°±11.23°vs-7.31°±9.55°,P=0.031)during surgery were significantly higher in MC group compared to the NMC group.In group R,the FI%of paraspinal muscles in each lumbar segment of patients with postoperative MC was higher than that in patients without MC(P<0.05).In the R and N groups,there was no significant difference inthe SCSA of the lumbar paravertebral muscles between patients with postoperative MC and those without MC at each level(all P>0.05).Multivariate logistic regression analysis showed that the average FI%of lumbar PSM was correlated with the occurrence of MC after spinal fusion in DS patients.The average FI%of lumbar PSM≥22.63%was a risk factors for MC after spinal fusion(P=0.010,OR=1.088,95%CI:1.020-1.160).Conclusions Female DS patients with higher degree of preoperative paraspinal muscle degeneration have a higher incidence of postoperative mechanical complications.For these patients,.there is still a higher risk of mechanical complications after surgery even if the ideal Roussouly classification is restored after surgery.