腰椎椎间融合术后邻近节段退变的术前相关因素回顾性分析

Retrospective analysis of preoperative risk factors of adjacent segment degeneration after posterior lumbar interbody fusions

目的分析术前各种伴随疾病对腰椎椎间融合术后邻近节段退变(ASDeg)的影响并筛选风险预测因子。方法回顾分析2010—2014年于中山大学孙逸仙纪念医院脊柱外科接受腰椎椎间融合手术资料完整的482例患者术前各种伴随疾病和生活方式与手术椎体邻近节段退变(ASDeg)的相关性。对各项伴随疾病与ASDeg间相关性采用单因素卡方检验,对年龄与ASDeg间相关性则采用ANOVA检验。结果 482例患者中,男221例(45.9%),女261例(54.1%),平均年龄55.4(18~91)岁。术后平均随访40.8(24~48)个月,共发现ASDeg 91例(18.9%)。Logistic回归分析发现,在围手术期伴随疾病和生活方式因素中,ASDeg的独立风险因素有:年龄(OR=0.977,P=0.021)、吸烟史(OR=2.580,P=0.001)、2型糖尿病(OR=0.091,P=0.001)和既往腰椎手术史(OR=0.091,P=0.000)。结论在影响腰椎椎间融合术后ASDeg的个体因素中,年龄、吸烟史、2型糖尿病和既往腰椎手术史是重要独立风险因素。

Objective To analyze the influence of preoperative diseases and unhealthy lifestyles on postoperative adjacent segment degeneration （ ASDeg） after lumbar intervertebral fusion and to screen the risk prediction factors through the case analysis. Methods In this study, from 2010 to 2014, 482 cases who had underwent the lumbar intervertebral fusion surgery in Sun Yat-sen Memorial Hospital were retrospectively ana-lyzed according to the objective. One factor chi square test was used to examine the correlation between disease and ASDeg, and the ANOVA test was used for the correlation between age and ASDeg. Results In the 482 patients, there were 221 （45. 9% ） males and 261 （54.1% ） females in mean age of 55. 4 （18-91） years old. The mean follow-up period was 40. 8 （24-48） months. Ninety-one （18. 9% ） cases were found with ASDeg in at least 1 year after surgery. With logistic regression analysis, it was found that in the perioperative accompa-nied disease and lifestyle factors, ASDeg independent risk factors were including age （ OR = 0.977, P = 0.021） , smoking history （ OR = 2 .580, P= 0 . 001） , type 2 diabetes mellitus （ OR = 0 .0 9 1 , P = 0 .001） and previous lumbar spine surgery （ OR = 0 .091 , P = 0 .000 ） . Conclusion The age, smoking history, type 2 dia-betes and the history of lumbar spine surgery are the important independent risk factors of ASDeg after lumbar interbody fusion.