椎间孔入路腰椎间融合内固定治疗腰椎间盘退行性疾病:患者体质量指数与翻修率的关系

Transforaminal lumbar interbody fusion for degenerative disc diseases: relationship between body mass index and revision rate

背景:肥胖对于脊柱外科手术的影响越来越受到重视,尤其是对术后翻修的影响。但是,对于微创椎间孔入路腰椎椎间融合内固定术,肥胖是否会影响其翻修率目前仍不清楚。目的:探究退变性腰椎疾病患者体质量指数数值是否会影响微创椎间孔入路腰椎椎间融合内固定术后翻修率。方法:共纳入143例接受单节段微创椎间孔入路腰椎椎间融合内固定术的患者,根据患者体质量指数分为正常组(体质量指数<25 kg/m2)、超重组(体质量指数25-29.9 kg/m2)、Ⅰ度肥胖(体质量指数30-34.9 kg/m2)、Ⅱ-Ⅲ度肥胖(体质量指数≥35 kg/m2)。统计对比各组术前、术后6周、术后12周、术后6个月腰痛目测类比疼痛评分及术后6周Oswestry功能障碍指数,采用线性回归控制年龄、性别及改良Charlson合并症评分。应用多变量Cox比例风险分析评价体质量指数与术后翻修率的相关性。结果与结论:(1)修复手术效果确切;(2)术后腰痛目测类比评分改善明显,随访期内各体质量指数组间术后目测类比疼痛评分及Oswestry功能障碍指数差异未见显著性意义;(3)高体质量指数患者术前合并症风险更高(P=0.001),高体质量指数会导致手术时间延长(P=0.000);(4)Cox比例风险分析模型结果认为,高体质量指数并非是微创椎间孔入路腰椎椎间融合内固定术翻修的独立危险因素(P=0.299);(5)提示在微创椎间孔入路腰椎椎间融合内固定术后2年的随访期内,体质量指数与术后翻修率并未呈现出正相关关系。因此,对高体质量指数患者和其术者而言,接受微创椎间孔入路腰椎椎间融合内固定术并不需要承担比正常体质量患者更高的风险。

BACKGROUND： With the increase of obesity population, more intension has been focused on its influence on spinal surgery, especially revision. However, effect of obesity on the revision after minimally invasive transforaminal lumbar interbody fusion（MIS-TLIF） remains unclear.OBJECTIVE： To explore whether body mass index（BMI） of the patients with lumbar degenerative diseases will impact the revision rate following MIS-TLIF. METHODS： Totally 143 patients undergoing single-segment MIS-TLIF were enrolled. The patients were allocated into four groups based on BMI： normal group（BMI 25 kg/m2）, overweight group（BMI of 25-29.9 kg/m2）, obesity I group（BMI of 30-34.9 kg/m2）, and obesity II-III group（BMI ≥ 35 kg/m2）. The low back pain Visual Analogue Scale score at baseline, 6, 12 weeks, and 6 months postoperatively, and Oswestry Disability Index at postoperative 6 months were recorded. Age, sex and modified Charlson Comorbidity Index were analyzed by linear regression. The correlation of BMI with revision rate was evaluated by multivariate Cox proportional hazards model. RESULTS AND CONCLUSION：（1） The treatment outcomes of MIS-TLIF were satisfactory.（2） The postoperative low back pain Visual Analogue Scale scores were significantly improved, and the postoperative scores and Oswestry Disability Index showed no significant differences among groups.（3） Increasing BMI manifested association with more preoperative comorbidities（P=0.001） and longer operation time（P=0.000）.（4） Cox proportional hazards model revealed that increasing BMI was not the independent risk factor for revision rate following MIS-TLIF（P=0.299）.（5） Our results indicate that increasing BMI is not a risk factor for revision procedures within 2 years after MIS-TLIF. Therefore, surgeons need not be anxious about high BMI patients after MIS-TLIF for its potential high revision rate.