TLIF手术后腰椎前凸矫正情况的影像学相关因素分析

Analysis of imaging factors related to the correction of lumbar lordosis after TLIF operation

目的 探讨影响经椎间孔腰椎椎体间融合术(transforaminal lumbar interbody fusion, TLIF)术后前凸矫正的影像学因素。方法 选择2016年1月~2020年6月在本院接受TLIF手术治疗的腰椎退行性疾病患者137例,通过术前和术后X线片记录患者术前腰椎前凸角及其他影像学特征数据,观察患者术后的前凸矫正度数,并将之分为A组(≥5°)和B组(<5°)组,比较两组影像学特征,并分析与术后前凸矫正相关的的影像学影响因素。结果 137例患者术后平均前凸矫正度数为(3.1±3.4)°。A、B两组患者年龄、病程等资料相比,差异存在统计学意义(P<0.05)。A组椎间盘真空征发生率显著高于B组(P<0.05),节段性前凸角、节段性椎间盘角显著低于B组(P<0.05)。两组患者腰椎前凸角、椎间盘间隙高度(前缘、后缘)、节段平移、滑移分度、Meyerding分级Ⅱ级等临床资料相比,差异均无统计学意义(P>0.05)。多因素Logistic分析显示,仅节段性前凸角≥17°是术后前凸矫正<5°的风险因素(P<0.05)。结论 术前节段性前凸角≥17°可能影响TLIF的前凸矫正结果,根据术前影像学结果有助于合理选择TLIF手术方式。

Objective To investigate the imaging factors affecting kyphosis correction after transforaminal lumbar interbody fusion(TLIF). Methods From January 2016 to June 2020, 137 patients with lumbar degenerative disease who received TLIF in our hospital were selected in this research. The preoperative and postoperative X-ray films of the patients were observed, and the preoperative lumbar lordosis and other imaging features were recorded, and the degree of correction of the patients’ lordosis was observed. According to the degree of correction, the patients were divided into group A(≥5°) and group B(<5°). Results The average degree of correction was(3.1±3.4)°. There were statistically significant differences in age and course of disease between the two groups(P<0.05). The incidence rate of vacuum sign in group A was significantly higher than that in group B(P<0.05), and segmental lordosis and segmental disc angle were lower in group A than those in group B(P<0.05). There were no significant differences in lumbar lordosis, intervertebral disc height(anterior and posterior edge), segmental translation, slip degree, Meyerding grade II between the two groups(P>0.05). Multivariate logistic analysis showed that only segmental lordosis ≥17° was the risk factor of postoperative kyphosis<5° after surgery(P<0.05). Conclusion Preoperative segmental lordosis≥17° may affect the results of TLIF lordosis correction, and preoperative imaging results is helpful to reasonably select the operation mode of TLIF.