显微内窥镜辅助OLIF手术治疗腰椎退行性疾病术后冠状面失平衡的logistic回归分析

Risk factors analysis of coronal imbalance after oblique lumbar interbody fusion and microscopic endoscope for degenerative lumbar disease

目的探讨显微内窥镜辅助斜外侧腰椎间融合术(oblique lumbar interbody fusion,OLIF)治疗腰椎退行性疾病术后冠状面失平衡的风险因素。方法选择2017年6月~2018年6月于本院行显微内窥镜辅助OLIF手术治疗的腰椎退行性疾病患者104例为研究对象,随访1年后,根据患者是否出现冠状面失平衡,分为冠状面失平衡组(A组)37例,冠状面平衡组(B组)67例。测量患者术前及随访1年后的冠状面Cobb角、冠状面平衡距离(CBD)、顶椎偏距(AVT)、顶椎旋转(AVR)、腰骶弯(LSC)Cobb角和L_(5)倾斜角(L_(5) TA)。计算上述影像学参数变化值。对两组影像学参数进行单因素分析,初步筛选术后冠状面失平衡的影响因素。再将上述初步筛选的影响因素和组间有统计学意义的影像学参数变化值采用多因素Logistic回归分析,筛选危险因素。结果随访1年后,A组患者术前冠状面Cobb角、CBD、AVT、AVR、LSC Cobb角、L_(5) TA显著大于B组(P<0.05);单因素分析显示,术前L_(5) TA、LSC Cobb角是术后冠状面失平衡的影响因素(P<0.05)。多因素Logistic回归分析显示,术前L_(5) TA≥15°和LSC Cobb≥15°是术后发生冠状面失平衡的独立危险因素。结论术前L_(5) TA≥15°和术前LSC Cobb角≥15°是OLIF手术治疗腰椎退行性疾病发生冠状面失平衡的危险因素,建议医生术前关注患者L_(5) TA和LSC Cobb角。

Objective To explore the risk factors of coronal imbalance after oblique lumbar interbody fusion(OLIF)and microscopic endoscope for degenerative lumbar disease.Methods From June 2017 to June 2018,104 patients with degenerative lumbar disease who received microscopic endoscope assisted OLIF.surgery were selected in this study.Patients were divided into imbalance group(group A,37 cases)and balance group(group B,67 cases)according to state of coronal imbalance measured after one year.The radiographic parameters included coronal Cobb angle,coronal balance distance(CBD),apical vertebral translation(AVT),apical vertebral rotation(AVR),Cobb angle of lumbar sacral curve(LSC),and L_(5) tilt angle(L_(5) TA)were measured preoperation and 1 year after operation.The changes of the above radiographic parameters were calculated.Univariate analysis was performed in radiographic parameters of two groups to preliminarily screen the influencing factors of postoperative coronal imbalance.Multivariate logistic regression analysis was performed to verify the risk factors from the preliminarily screened influence factors and the variance of imaging parameters with significant difference between the two groups.Results The coronal Cobb angle,CBD,AVT,AVR,LSC Cobb angle,and L_(5) TA in group A were significantly higher than those in group B before operation(P<0.05).Univariate analysis showed that preoperative L_(5) TA and LSC Cobb angle were the influencing factors of postoperative coronal imbalance(P<0.05).Multivariate logistic regression analysis showed that preoperative L_(5) TA≥15°and LSC Cobb≥15°were independent risk factors of postoperative coronal imbalance.Conclusion Preoperative L_(5) TA≥15°and LSC Cobb angle≥15°are independent risk factors for coronal imbalance in patients with degenerative lumbar scoliosis after OLIF surgery.