肥胖因素对后路椎间融合术治疗双节段腰椎退行性疾病的影响

Influence of obesity on the treatment of two-level lumbar degenerative diseases by posterior lumbar interbody fusion

目的探讨肥胖因素在腰椎后路椎间融合术治疗双节段腰椎退行性疾病中的影响。方法选取2015年1月~2018年12月本院骨科行腰椎后路椎间融合术的双节段腰椎椎间盘退变性疾病患者154例。按照体质量指数(body mass index,BMI)分成三组:BMI<25 kg/m^(2)纳入正常组,BMI在25.0~29.9 kg/m^(2)纳入超重组,BMI≥30 kg/m^(2)纳入肥胖组。所有患者随访至少1年,比较围手术期指标、VAS评分和ODI指数、植骨融合情况、术后并发症等。结果肥胖组、超重组手术时间显著高于正常组(P<0.05),肥胖组住院时间、并发症发生率显著高于正常组、超重组(P<0.05);三组患者术后3个月、6个月、末次随访时的VAS评分和ODI指数均较术前有显著改善(P<0.05),但组间比较无显著差异(P>0.05);三组的最终融合率接近,无统计学差异(P>0.05)。结论肥胖患者行双节段腰椎后路椎体融合术,其手术时间、住院时间均有增加,术后并发症发生率偏高,但对总体疗效并无显著影响。

Objective To evaluate the influence of obesity on the treatment of two-level lumbar degenerative diseases by posterior lumbar interbody fusion.Methods From January 2015 to December 2018,154 consecutive patients with two-level lumbar degenerative disease were treated by posterior lumbar interbody fusion.The patients were assigned into three groups according to the body mass index(BMI):normal group(BMI<25 kg/m^(2)),over-weight group(25.0≤BMI≤29.9 kg/m^(2)),and obesity group(BMI>30 kg/m^(2)).The follow-up period was at least 12 months.The indicators of perioperative period,VAS score,ODI index,bone graft and surgical complications were compared among the three groups.Results Compared with the normal group,the operation time was significantly increased in the over-weight group and obesity group(P<0.05).Compared with the normal group and over-weight group,the hospitalization time and incidence rate of complications were significantly increased in the obesity group(P<0.05).Compared with before operation,the ODI index and VAS score were significantly improved in three groups at 3,6 months after operation and the final follow-up(P<0.05),but no significant difference was detected among the three groups(P>0.05).In terms of bone graft fusion rate,no significant difference was detected among the three groups(P>0.05).Conclusion The operation time and hospitalization time of obesity patients with two-level posterior lumbar interbody fusion are increased,and the incidence rate of postoperative complications is high,but the overall effect is not affected.