微创经椎间孔入路腰椎融合术后融合节段和邻近节段椎旁肌退变及其与患者生活质量的相关性分析

Postoperative paravertebral muscle degeneration and its correlations with health related quality of life in patients undergoing minimally invasive surgery-transforaminal lumbar interbody fusion

目的分析微创经椎间孔入路腰椎融合术(MIS-TLIF)后融合节段与邻近节段的背侧肌肉、腰大肌、脂肪变性率的变化,及其与患者术后健康相关生活质量(HRQL)评分的相关性。方法回顾性分析2019年1月至2021年12月河南省人民医院脊柱脊髓外科行单节段腰椎MIS-TLIF术治疗的50例患者资料。男22例,女28例;年龄为(44.7±4.6)岁(41~50岁)。分别比较患者融合节段与邻近节段术前、术后6、12个月的腰椎背侧肌肉相对体积、腰大肌相对体积及脂肪变性率,分析融合节段与邻近节段术后12个月HRQL评分[疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)]与腰椎背侧肌肉相对体积、腰大肌相对体积、脂肪变性率的相关性。结果融合节段与邻近节段术后6、12个月的腰椎背侧肌肉相对体积、腰大肌相对体积均较术前显著减小,脂肪变性率均较术前显著增加,但融合节段术后12个月的脂肪变性率(20.6%±6.1%)较术后6个月(29.7%±8.2%)显著减少,差异均有统计学意义(P<0.05)。VAS评分与融合节段背侧肌肉相对体积(r=-0.819,P<0.001)、脂肪变性率(r=0.86,P<0.001)呈极强负相关和极强正相关,与腰大肌相对体积(r=-0.435,P=0.016)呈中等负相关;ODI指数与融合节段背侧肌肉相对体积(r=-0.512,P=0.004)、腰大肌相对体积(r=-0.402,P=0.020)呈中等程度负相关,与融合节段脂肪变性率呈中等程度正相关(r=0.565,P=0.001)。ODI指数与邻近节段背侧肌肉相对体积(r=-0.478,P=0.012)呈中等程度负相关。结论MIS-TLIF术后椎旁肌肉体积出现了萎缩,同时背侧肌肉出现脂肪变性,融合节段背侧肌肉脂肪变性至随访12个月出现好转,邻近节段脂肪变性则在随访期内未见明显改善。与术后HRQL评分关系最密切的是融合层面背侧肌肉相对体积和脂肪变性率。

Objective To analyze the postoperative paravertebral muscle degeneration and its correlations with health related quality of life(HRQL)in patients undergoing minimally invasive surgery-transforaminal lumbar interbody fusion(MIS-TLIF).Methods The clinical data of the 50 patients were retrospectively analyzed who had undergone single-segmental MIS-TLIF at Department of Spinal Cord Surgery,The People's Hospital of Henan Province from January 2019 to December 2021.The relative volumes of lumbar posterior muscle(LM),the relative volumes of the psoas major(PM),and the rates of fatty degeneration(FD)of the fused segment and its adjacent segments were compared respectively between preoperation,6 and 12 months postoperation.The correlations were analyzed between the HRQL scores[visual analog scale(VAS)for pain and Oswestry disability index(ODI)]and the relative LM volumes,the relative PM volumes,and the FD rates of the fused segment and its adjacent segments at 12 months postoperation.Results Compared with the preoperative values,the relative LM volumes and the relative PM volumes of the fused segment and its adjacent segments at 6 and 12 months postoperation were significantly reduced while the FD rates significantly increased.However,the FD rate of the fused segment at 12 months postoperation(20.6%±6.1%)was significantly lower than that at 6 months postoperation(29.7%±8.2%)(P<0.05).The VAS score was strongly negatively or positively correlated with the relative LM volume(r=-0.819,P<0.001)and the FD rate(r=0.86,P<0.001)of the fused segment,and moderately negatively correlated with the relative PM volume(r=-0.435,P=0.016).The ODI index was moderately negatively correlated with the relative LM volume(r=-0.512,P=0.004)and the relative PM volume(r=-0.402,P=0.020)of the fused segment,but moderately positively correlated with the FD rate of the fused segment(r=0.565,P=0.001).There was a moderate negative correlation between the ODI index and the relative LM volume of the adjacent segments(r=-0.478,P=0.012).Conclusions After MIS-TLIF,the volume of the paravertebral muscles decreases and the dorsal muscles develop fatty degeneration.The improvement of LM fatty degeneration may be observed by 12-month follow-up in the fused segment,but not in the adjacent segments.The LM volume and the FD rate of the fused segment are the most closely related to the postoperative HRQL.