腰椎融合术后发生邻近节段退变的相关因素分析

Analysis of the related factors of adjacent segment degeneration after lumbar spinal fusion

目的探讨腰椎退行性疾病行腰椎融合手术后,发生邻近节段退变(Adjacentsegment degeneration,ASD)的相关因素。方法自2011-09-2014-09,共纳入287例行腰椎后路融合手术治疗的腰椎退行性疾病患者,均由同一组医师进行腰椎融合手术,术后随访37-60个月。依据其术后是否发生ASD,将其分为ASD组23例和非ASD组264例,统计两组患者的性别、年龄、手术方式、术中是否进行椎板切除、是否行悬浮固定,邻近节段椎间盘再术前是否存在退变等相关数据。将上述数据作为自变量,并将ASD发生与否作为因变量,进行与ASD相关的组间单因素分析,以及多因素Logistic回归分析。结果单因素分析发现,年龄、手术方式、术前邻近节段有椎间盘退变,均与之关系密切;而进一步的多因素Logistic回归分析发现,手术方式为PLIF、术前有邻近节段的椎间盘退变、患者年龄在60岁以上,均是术后发生ASD的独立危险因素(均为P<0.05)。结论在腰椎融合手术治疗腰椎退行性疾病中,年龄在60岁以上、采用PLIF术式、术前邻近节段有退变者,其术后发生ASD的风险较高。

Objective To investigate the related factors of adjacent segment degeneration （ASD）after lumbar spinal fusion surgery for degenerative lumbar diseases. Methods From September 2011to September 2014, a total of 287 patients with lumbar degenerative disease treated by posteriorlumbar fusion were enrolled in the study. All patients underwent lumbar fusion surgery in the samegroup. The patients were followed up for 37 -60 months. According to the occurrence of ASD afteroperation, the patients were divided into ASD group （23 cases） and non ASD group （264 cases）. Thegender, age, surgery, intraoperative laminectomy and whether suspension fixation, adjacentintervertebral disc degeneration and preexisting data were analyzed in two groups. The above data wereused as independent variables, and the occurrence of ASD was used as the dependent variable. TheASD related single factor analysis and multi factor Logistic regression analysis were performed. ResultsUnivariate analysis showed that age, surgical approach, preoperative adjacent segments degeneration ofintervertebral disc were closely related with ASD. Multivariate Logistic stepwise regression analysisshowed that the operation mode PLIF, preoperative adjacent segment degeneration of intervertebraldisc, patients over 60 years old were independent risk factors of postoperative ASD （P 〈0.05）.Conclusion In the treatment of lumbar degenerative diseases with lumbar fusion surgery, the risk ofASD is higher in patients over 60 years old, PLIF type and adjacent segment degeneration.