体质量指数对后路360°融合术治疗单节段腰椎退行性疾病疗效的影响

EFFECT OF BODY MASS INDEX ON OUTCOME OF POSTERIOR 360° FUSION FOR SINGLE-LEVEL LUMBAR DEGENERATIVE DISEASES

目的探讨体质量指数(body mass index,BMI)对后路360°融合术治疗单节段腰椎退行性疾病疗效的影响。方法回顾分析2009年9月-2013年9月收治的符合选择标准的302例行后路360°融合术治疗的单节段腰椎退行性疾病患者临床资料。根据术前BMI不同将患者分为3组,A组为正常体重组(BMI<24kg/m^2),105例;B组为超重组(24 kg/m^2≤BMI<28 kg/m^2),108例;C组为肥胖组(BMI≥28 kg/m^2),89例。3组患者性别、年龄、病程、病变类型、病变节段及术前日本骨科协会(JOA)评分与Oswestry功能障碍指数(ODI)比较差异均无统计学意义(P>0.05),具有可比性。记录患者手术时间、术中出血量、术后住院时间、术后并发症情况;术前及术后3、6、24个月采用腰椎JOA评分及ODI评价患者腰椎功能情况。结果 C组手术时间、术中出血量及术后住院时间均显著多于A、B组(P<0.05);A、B组间比较差异无统计学意义(P>0.05)。3组患者均获2年以上随访,随访时间24~45个月。各组术后各时间点JOA评分及ODI均较术前显著改善(P<0.05);术后各时间点3组间比较,差异均无统计学意义(P>0.05)。并发症发生情况:3组患者术后总体并发症发生率比较差异无统计学意义(χ~2=3.288,P=0.193)。其中C组切口相关并发症(切口感染和切口愈合不良)发生率显著高于A、B组(P<0.05),A、B组间差异无统计学意义(P>0.05);脑脊液漏、假关节形成及翻修等并发症发生率3组间比较差异均无统计学意义(P>0.05)。结论不同BMI的腰椎退行性疾病患者行后路360°融合术均能获得良好临床疗效,但BMI≥28 kg/m^2患者手术时间更长、术中出血更多、术后住院时间更长,且术后切口相关并发症发生率更高。

Objective To investigate the effect of body mass index（BMI） on the outcome of posterior 360°fusion for single-level lumbar degenerative diseases.Methods A retrospective study was carried on 302 cases of singlelevel lumbar degenerative diseases treated with posterior 360° fusion between September 2009 and September 2013.All patients were divided into 3 groups according to BMI：normal weight（BMI24 kg/m^2） in 105 cases（group A）,overweight（24 kg/m^2≤BMI28 kg/m^2） in 108 cases（group B）,and obese（BMI≥28 kg/m^2） in 89 cases（group C）.There was no significant difference in gender,age,disease duration,disease patterns,affected segments,preoperative Japanese Orthopaedic Association（JOA） score and Oswestry disability index（ODI） among 3 groups（P〈0.05）.The operation time,intraoperative blood loss,postoperative hospital stay,and complications were recorded.The lumbar function was assessed by JOA score and ODI at pre- and post-operation（at 3,6,and 24 months）.Results The operation time,intraoperative blood loss,and postoperative hospital stay of group C were significantly more than those of groups A and B（P〈0.05）,but no significant difference was found between group A and group B（P〈0.05）.The patients were followed up 24-45 months.Postoperative JOA score and ODI showed significant improvements in each group when compared with preoperative ones（P〈0.05）,but there was no significant difference among groups at each time point after operation（P〈0.05）.There was no significant difference in the incidence of total complications among 3 groups（χ~2=3.288,P=0.193）.The incidence of incision-related complications（infection and poor healing） in group C was significantly higher than that of groups A and B（P〈0.05）,but no significant difference was shown between group A and group B（P〈0.05）.However,there was no significant difference in cerebrospinal fluid leak,pseudarthrosis formation,and revision among 3 groups（P〈0.05）.Conclusion Posterior 360° fusion for single-level lumbar degenerative diseases can obtain good effectiveness in patients with different BMI,but patients whose BMI was ≥28 kg/m^2 have longer operation time,more intraoperative blood loss,longer hospital stay,and higher incidence of postoperative incision-related complications.