术前椎旁肌变性对单节段PE-PLIF手术早期疗效的影响

The Effect of Preoperative Paravertebral Muscle Degeneration on the Early Outcome of Single-Level PE-PLIF Surgery

目的探讨术前椎旁肌和腰大肌横截面积(cross sectional area,CSA)的减少及脂肪浸润程度(fatty infiltration,FI)与患者术前疼痛程度以及功能状态的相关性,以及是否会影响经皮内窥镜腰椎后路椎体间融合术(percutaneous endoscopic posterior lumbar interbody fusion,PE-PLIF)的手术治疗结果。方法选取2021年9月至2022年9月在山西白求恩医院骨科住院符合标准且为初次行单节段PE-PLIF手术的腰椎退行性疾病患者共110例,其中男61例,女49例;年龄35~70岁,平均(51.98±13.49)岁。测量患者术前椎旁肌和腰大肌相对横截面积(relative cross sectional area,rCSA)以及椎旁肌的脂肪浸润。评估术前及术后Oswestry功能障碍指数(oswestry dability index,ODI)和疼痛视觉模拟评分(visual analogue scale,VAS)。使用Pearson和Spearman相关系数计算变量之间的相关性。Kruskal-Wallis检验用于比较不同椎旁肌和腰大肌rCSA以及不同程度椎旁肌脂肪变性的亚组之间的结果。结果椎旁肌脂肪浸润与术前ODI以及腰背部VAS评分显著相关(r=0.420,P<0.001和r=0.215,P=0.024);术后1个月和6个月ODI评分显示,椎旁肌脂肪浸润与术后良好的预后相关(r=0.208,P=0.030和r=0.192,P=0.044)。结论椎旁肌的脂肪浸润与术前患者的疼痛以及功能障碍密切相关,与术后1个月、6个月的良好预后相关。

Objective To investigate the correlation between the reduction in cross sectional area(CSA)and fatty infiltration(FI)of anterior paraspinal muscles and psoas major muscles,and the degree of pain and functional status prior to surgery.Furthermore,we aim to determine whether these factors influence the surgical outcomes of percutaneous endoscopic posterior lumbar interbody fusion(PE-PLIF).Methods A total of 110 patients with lumbar degenerative diseases who met the criteria and underwent single-level PE-PLIF surgery for the first time in the Orthopaedics Department of Shanxi Bethune Hospital from September 2021 to September 2022 were selected.The cohort consisted of 61 males and 49 females,ranging in age from 35 to 70 years,with an average age of(51.98±13.49)years.Prior to surgery,the relative cross sectional area(rCSA)of the paraspinal muscles and psoas major muscles,as well as the fatty infiltration of the paraspinal muscles,were measured.The Oswestry disability index(ODI)and visual analogue scale(VAS)were used to evaluate the patients’condition before surgery and at 1,6,and 12 months post-surgery.The correlations between variables were calculated using Pearson’s and Spearman’s correlation coefficients.The Kruskal-Wallis test was employed to compare the outcomes between subgroups with different rCSA values of the paraspinal and psoas major muscles and varying degrees of paraspinal muscle fatty infiltration.Results Paraspinal muscle fat infiltration was significantly correlated with ODI and VAS scores before operation(r=0.420,P<0.001 and r=0.215,P=0.024).ODI scores at 1 month and 6 months after surgery showed that paraspinal muscle fat infiltration was associated with good prognosis(r=0.208,P=0.030 and r=0.192,P=0.044).Conclusion Paraspinal muscle fat infiltration is closely related to pain and dysfunction before operation,and is associated with good prognosis at 1 month and 6 months after operation.