经椎间孔腰椎椎间融合术后邻近节段疾病的再手术率及其危险因素分析

Analysis of reoperation rate and risk factors of adjacent segment disease after transforaminal lumbar interbody fusion

目的探讨腰椎退行性疾病患者行经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)后邻近节段疾病(adjacent segment disease,ASDis)的再手术率及其危险因素。方法回顾性分析2011年1月至2013年12月因腰椎退行性疾病接受TLIF手术460例患者的临床资料,男204例、女256例;年龄(54.6±12.6)岁(范围20~85岁)。按照是否发生ASDis并再次接受手术治疗分为ASDis组和无ASDis组。ASDis组26例,男14例,女12例;年龄为(57.9±12.2)岁。无ASDis组434例,男188例、女246例;年龄为(54.4±12.5)岁。统计ASDis的再手术率,并比较两组间患者年龄、体质指数(body mass index,BMI)、合并症、手术相关参数、住院时间、手术前后影像学参数等,采用单因素分析和logistic回归分析ASDis再次手术的危险因素。结果TLIF手术后发生ASDis并接受再次手术者26例,再手术率为5.7%(26/460),其中术前邻近椎间盘Pfirrmann分级≥Ⅲ级患者的ASDis再手术率为53.1%(17/32)。ASDis的发病时间为(76.3±25.0)个月(范围30~111个月)。两组患者的BMI(t=3.86,P<0.001)、高血压病史(χ2=5.30,P=0.021)、术前邻近椎间盘退变(χ2=85.90,P<0.001)、术前邻近节段椎管狭窄(χ2=25.35,P<0.001)、术前邻近节段椎间隙高度下降(t=4.33,P<0.001)的差异有统计学意义。将上述指标纳入logistic回归模型进行分析,结果显示BMI>24.9 kg/m2和术前邻近椎间盘退变≥Ⅲ级是TLIF术后ASDis再次手术的危险因素。结论腰椎退行性疾病患者TLIF手术后ASDis再手术率为5.7%。BMI>24.9 kg/m2及术前存在邻近椎间盘退变≥Ⅲ级是TLIF术后ASDis再次手术的危险因素。

Objective To explore the reoperation rate and risk factors of adjacent segment disease(ASDis)in patients with lumbar degenerative diseases after transforaminal lumbar interbody fusion(TLIF).Methods The clinical data of 460 patients who underwent TLIF for lumbar degenerative diseases in our hospital from January 2011 to December 2013 were retrospectively analyzed.There were 204 males and 256 females with an age of 54.6±12.6 years(range,20-85 years).Divided into ASDis group and None ASDis(N-ASDis)group according to the occurrence of ASDis and received surgical treatment.The age of ASDis group was 57.9±12.2 years,with 14 males and 12 females,while the age of N-ASDis group was 54.4±12.5 years,with 188 males and 246 females.Count the reoperation rate of ASDis.Compare the age,body mass index(BMI),comorbidities,surgery-related parameters,length of stay,imaging parameters before and after surgery between the two groups,and use univariate analysis and logistic regression analysis to explore risk factors for ASDis.Results Among 460 patients who underwent TLIF due to lumbar degenerative diseases,26 patients developed ASDis and received surgical treatment,the reoperation rate was about 5.7%.Among them,the reoperation rate of ASDis with above Pfirrmann grade III in the adjacent intervertebral disc was about 53.1%(17/32).The average onset time of adjacent segment disease was 76.3±25.0 months(range,30-111 months).Univariate analysis showed that BMI(t=3.86,P<0.001),history of hypertension(χ2=5.30,P=0.021),preoperative adjacent vertebral disc degeneration(χ2=85.90,P<0.001),preoperative adjacent spinal canal stenosis(χ2=25.35,P<0.001),and preoperative intervertebral space height of adjacent segments(t=4.33,P<0.001)were statistically different among patients with or without ASDis.Incorporating the above indicators into the logistic regression model,the analysis results showed that body mass index(BMI)>24.9 kg/m2 and preoperative adjacent intervertebral disc degeneration≥III degree were risk factors for ASDis after TLIF.Conclusion The reoperation rate of ASDis after TLIF in patients with lumbar degenerative disease is about 5.7%.BMI>24.9 kg/m2 and preoperative adjacent intervertebral disc degeneration≥III degree are risk factors for ASDis and received surgical treatment after TLIF.