术前肌肉健康分级方法对椎弓根螺钉松动的预测分析

Predictive effect of preoperative muscle health grade on pedicle screw loosening

目的:探讨椎旁肌退变对腰椎后路椎间融合结合椎弓根螺钉固定(PLIF-PSF)术后椎弓根螺钉松动的影响,以预测PLIF-PSF术后椎弓根螺钉松动情况,为临床医师提供一种迅速、可靠的肌肉评估方法。方法:回顾性分析2016年10月至2021年10月采用PLIF-PSF治疗并随访1年及以上的腰椎间盘突出症伴腰椎不稳患者122例。患者术前进行腰椎MRI检查,在L4-5椎间盘水平测量腰椎压痕值(LIV)、椎旁肌横截面积/体重指数(PL-CSA/BMI)、Goutallier分级,并进行肌肉健康分级评估。通过术后腰椎CT评估椎弓根螺钉松动情况,将患者分为螺钉松动组和螺钉非松动组,并进一步根据骨质改变分为正常骨量、低骨量、骨质疏松组后进行螺钉松动亚组和螺钉非松动亚组的比较,分析椎旁肌退变对PLIF-PSF术后椎弓根螺钉松动的影响。结果:在LIV、PL-CSA/BMI方面,螺钉松动组与螺钉非松动组差异无统计学意义(P=0.142,0.082)。在Goutallier分级和肌肉健康分级方面,螺钉松动组与螺钉非松动组的差异存在统计学意义(P=0.001,0.001)。Logistic回归分析结果显示,骨质改变、肌肉健康分级是PLIF-PSF术后椎弓根螺钉松动的独立预测因素(P=0.039,0.012)。在骨质改变分组中,肌肉健康分级是低骨量、骨质疏松患者接受PLIF-PSF术后椎弓根螺钉松动的独立预测因素(P=0.008,0.039)。结论:相比LIV、PL-CSA/BMI、Goutallier分级,肌肉健康分级对PLIF-PSF术后椎弓根螺钉松动更具有预测优势,尤其在低骨量和骨质疏松患者中。椎旁肌的退变是影响PLIF-PSF术后椎弓根螺钉松动的重要危险因素。

Objective:To assess the influencing of paravertebral muscle degeneration on pedicle screw loosening after posterior lumbar interbody fusion combined with pedicle screw fixation(PLIF-PSF)so as to predict whether loosening or not of pedicle screw after PLIF-PSF and proride a rapid and reliable muscle assessment method for clinicians.Methods:Data of 122 patients with lumbar intervertebral disc protrusion and instability of lumbar spine receiving PLIF-PSF from October 2016 to October 2021 were retrospectively analyzed.All patients were followed up for over one year and had preoperative lumbar MRI,and lumbar indentation value(LIV),cross-sectional area of paralumbar muscles/body mass index(PL-CSA/BMI)and the Goutallier classification at the intervertebral disc of the L4-5 segment and the muscle health grade.Patients were divided into pedicle screw loosening group and pedicle screw non-loosening group by postoperative lumbar CT.The effect of lumbar paraspinal muscle degeneration on pedicle screw loosening after PLIF-PSF was further analyzed by subgrouping patients into normal bone mass,low bone mass and osteoporosis via bone mineral density(BMD).Results:There were no significant differences in LIV and PL–CSA/BMI between the loosening group and the non-loosening group(P=0.142 and 0.082,respectively).Significant differences in the Goutallier classification and the muscle health grade were detected between the loosening group and the non-loosening group(both P=0.001).Binary logistic analysis revealed that BMD and the muscle health grade were independent predictors for pedicle screw loosening(P=0.039 and 0.012,respectively).Subgrouping by BMD,the muscle health grade was still an independent predictor for pedicle screw loosening in low bone mass patients and osteoporosis patients(P=0.008 and 0.039,respectively).Conclusions:Compared with LIV,PL-CSA/BMI and the Goutallier classification,the muscle health grade can more effectively predict pedicle screw loosening after PLIF-PSF,especially in patients with low bone mass and osteoporosis.Lumbar paravertebral muscle degeneration is an important risk factor for pedicle screw loosening after PLIF-PSF.