骨质疏松症合并中重度椎旁肌脂肪浸润快速评分系统预测腰椎退变性疾病手术效果

Fast scoring system for osteoporosis with fat infiltration in paraspinal muscles and its prediction of surgical outcomes in lumbar degenerative diseases

目的探讨骨质疏松症(OP)合并中重度椎旁肌脂肪浸润快速评分系统对腰椎退变性疾病(LDD)手术效果的预测价值。方法分析2021年1月至2022年1月符合纳入标准于郑州大学第一附属医院郑东院区接受PLIF手术的141例患者作为研究对象,依据OP和中重度椎旁肌脂肪浸润的诊断分为无合并症组49例、OP或中重度椎旁肌脂肪浸润组68例和OP合并中重度椎旁肌脂肪浸润组24例,统计性别、年龄、症状持续时间、BMI、骨密度、术后出院日、出血量、手术节段数、双侧L3、L4、L5椎体下终板层面肌肉面积和脂肪浸润情况以及术前和术后复查时的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数问卷表(ODI)评分作为统计数据,按照有无合并症分为A组(无合并症组),B组(OP或中重度椎旁肌脂肪浸润组),C组(OP和中重度椎旁肌脂肪浸润组),应用SPSS(V26.0)进行统计分析,采用单因素方差分析,t检验比较3组患者手术预后指标。结果本研究中3组患者中性别、年龄、症状持续时间、BMI、术后出院日、出血量、手术节段数差异无统计学意义(P>0.05),3组患者各层面椎旁肌FCSA和FI%在大多数测量位点差异有统计学意义(P<0.05)。术后12个月C组VAS评分高于A、B组[(2.54±1.18)分比(0.84±1.11)、(1.29±1.19)分,F=17.63,P<0.05],ODI评分也高于A、B组[(24.25±11.78)分比(13.02±8.84)、(15.37±7.95)分,F=12.93,P<0.05],术后6个月C组VAS评分高于A、B组[(2.63±1.10)分比(0.94±1.09)、(1.34±1.23)分,F=17.34,P<0.05],ODI评分高于A、B组[(24.00±12.22)分比(13.61±8.91)、(16.31±8.72)分,F=10.19,P<0.05],术后3个月C组VAS评分高于A、B组[(4.04±1.23)分比(3.08±1.06)、(3.56±1.29)分,F=5.46,P<0.05],ODI评分也高于A、B组[(24.21±12.20)分比(17.04±8.38)、(21.26±11.45)分,F=4.10,P<0.05]。结论快速评分系统能够在一定程度上预测手术效果,为有相关合并症的LDD的治疗及围术期管理提供参考。

Objective To study the predictive value of a fast scoring system for osteoporosis(OP)with fat infiltration in paraspinal muscles in surgical outcomes of lumbar degenerative diseases(LDD).Methods Totally,141 patients who underwent PLIF surgery at The First Affiliated Hospital of Zhengzhou University from January 2021 to January 2022 were divided into three groups:a group without complications(group A,49 patients),a group with either OP or moderate to severe paraspinal muscle fat infiltration(group B,68 patients),and a group with both OP and moderate to severe paraspinal musclefat infiltration(group C,24 patients).Factors that could potentially affect surgical outcomes,such as gender,age,duration of symptoms,body mass index(BMI)(kg/m2),bone mineral density(BMD),length of hospital stay,blood loss,number of surgical segments,muscle area at the lower endplate of bilateral L3,L4,L5 vertebrae,extent of fatty infiltration,and pre-and postoperative visual analog scale(VAS)pain scores and ODI scores,were collected as statistical data.Statistical analysis using SPSS(V26.0)involved one-way ANOVA and t-tests to compare surgical outcomes among the three groups based on the presence or absence of complications.Results In this study,there were no statistical differences in gender,age,duration of symptoms,BMI,length of hospital stay,blood loss,and number of surgical segments among the three groups.However,significant differences(P<0.05)were observed in most measured parameters of the paravertebral muscles,including cross-sectional area(FCSA)and fat infiltration percentage(FI%),among the three groups.After 12 months post-surgery,group C exhibited higher VAS scores than group A and group B[(2.54±1.18)vs.(0.84±1.11),(1.29±1.19),F=17.63,P<0.05].The ODI scores were also higher in group C than groups A and B[(24.25±11.78)vs.(13.02±8.84),(15.37±7.95),F=12.93,P<0.05].At 6 months post-surgery,group C had higher VAS scores than groups A and B[(2.63±1.10)vs.(0.94±1.09),(1.34±1.23),F=17.34,P<0.05],and ODI scores were higher than groups A and B[(24.00±12.22)vs.(13.61±8.91),(16.31±8.72),F=10.19,P<0.05].At 3 months post-surgery,group C showed higher VAS scores than groups A and B[(4.04±1.23)vs.(3.08±1.06),(3.56±1.29),F=5.46,P<0.05],and ODI scores were also higher than groups A and B[(24.21±12.20)vs.(17.04±8.38),(21.26±11.45),F=4.10,P<0.05].Conclusion The rapid scoring system can predict the surgical outcomes,providing assistance and reference for the treatment and perioperative management of LDD with complications.