终板体积骨密度在侧方入路腰椎椎体间融合术后Cage沉降的预测价值

The predicative value of endplate volumetric bone mineral density in Cage sedimentation after lateral lumbar interbody fusion

目的探讨终板体积骨密度(endplate volumetric bone mineral density,EP-vBMD)对侧方入路腰椎融合(lateral lumbar interbody fusion,LLIF)术后Cage沉降的影响。方法选择2018年1月~2020年12月在本院接受LLIF手术治疗的151例患者进行回顾性分析,收集患者EP-vBMD、椎体体积骨密度(vertebral body volumetric bone mineral density,VB-vBMD)、年龄、性别、体质量指数(body mass index,BMI)、医学共病(糖尿病等)、吸烟、美国麻醉医师协会(american society of anesthesiologists,ASA)评分、查尔森共病指数(charlson comorbidity index,CCI)、手术节段、手术椎体和是否使用后路螺钉固定等资料。根据术后1年患者是否发生Cage沉降,将患者分为Cage沉降组和非沉降组,比较两组患者临床资料差异,将单因素分析P<0.2的变量进一步采用多因素Logsitic回归分析,观察EP-vBMD对终板沉陷的影响。结果Cage沉降患者的VB-vBMD和EP-vBMD水平均低于非Cage沉降患者,差异均有统计学意义(P<0.05)。Cage沉降组患者年龄高于非Cage沉降组患者,差异有统计学意义(P<0.05);Cage沉降组和非Cage沉降组患者性别、吸烟、糖尿病、后路螺钉固定等资料差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,EP-vBMD和应用后路螺钉固定均是Cage沉降的保护性因素(P<0.05)。结论低EP-vBMD是LLIF术后Cage沉降的风险因素,对患者进行LLIF时,应考虑术前EP-vBMD的测量。

Objective To investigate the effect of endplate volumetric bone mineral density on Cage sedimentation after lateral lumbar interbody fusion(LLIF).Methods The clinical data of 151 patients who underwent LLIF surgery in our hospital from January 2018 to December 2020 were analyzed retrospectively.End plate trabecular bone volume bone mineral density(EP-vBMD),vertebral body volume bone mineral density(VB-vBMD),age,gender,body mass index(BMI),medical comorbidity(diabetes mellitus),smoking,American Anesthesiologist Association(ASA)score,Charlson comorbidity index(CCI),operative segment,surgical vertebral body and whether to use posterior screw were collected.The patients were divided into Cage sedimentation group and non sedimentation group according to whether Cage sedimentation occurred one year after operation.The differences in clinical data between the two groups were compared.The independent variables with P<0.2 in univariate analysis were included in multivariate logistic analysis to observe the effect of EP-vBMD on endplate sedimentation.Results The levels of VB-vBMD and EP-vBMD in patients with Cage sedimentation were lower than those in patients without Cage sedimentation(P<0.05).The age of patients in Cage sedimentation group was significantly higher than that in non Cage sedimentation group(P<0.05).There was no significant difference in BMI,ASA,CCI and operative vertebral body between Cage sedimentation group and non Cage sedimentation group(P>0.05).There were significant differences in gender,smoking,diabetes and posterior screw between Cage sedimentation group and non Cage sedimentation group(P<0.05).Multivariate logistic analysis showed that EP-vBMD was the protective factor of Cage sedimentation(P<0.05),and posterior screw was the protective factor of Cage sedimentation(P<0.05).Conclusion Low EP-vBMD is a risk factor for Cage sedimentation after LLIF,and preoperative EP-vBMD measurement should be considered in patients with LLIF.