斜外侧腰椎椎间融合联合经皮椎弓根钉内固定后前凸角与融合器沉降的关系

Relationship between anterior convex angle and fusion cage settlement after oblique lumbar interbody fusion combined with percutaneous pedicle screw fixation

背景:随着医疗技术的不断进步,斜外侧腰椎椎间融合联合经皮椎弓根钉内固定已成为治疗腰椎退行性疾病的一种常用方法,然而关于术后不同节段前凸角变化与融合器沉降之间的关系尚缺乏深入研究。目的:探究斜外侧腰椎椎间融合联合经皮椎弓根钉固定后不同节段前凸角变化与融合器沉降的关系。方法:选择2019年2月至2023年4月于潍坊市中医院行斜外侧腰椎椎间融合联合经皮椎弓根钉固定治疗的腰椎退行性疾病患者93例为研究对象,根据术后椎间隙高度丢失值,分为融合器沉降组(25例,≥2 mm)和非融合器沉降组(68例,<2 mm)。采用多因素Logistic回归法分析融合器沉降的危险因素,应用逐步回归法评估各危险因素与融合器沉降的关系,构建风险预测模型并评价。结果与结论:①最终校正混杂因素后,腰椎前凸角丢失值和节段前凸角改善值均与融合器沉降风险仍存在独立相关性(P<0.05);②年龄、Oswestry功能障碍指数、椎间隙高度改善值、节段前凸角改善值以及腰椎前凸角丢失值,均是融合器沉降发生的独立影响因素(P<0.05),其中年龄、腰椎前凸角丢失值、椎间隙高度改善值和节段前凸角改善值与融合器沉降关联最紧密;③多元Logistic回归模型分析结果显示,当P=0.80时,约登指数最高,预测效果最好,准确度为89.27%,灵敏度为86.67%,特异度为89.89%;模型评价结果显示,其区分度较好、准确度较高;④随着腰椎前凸角丢失值和节段前凸角改善值升高,融合器沉降风险增加,影响临床疗效;⑤提示年龄、腰椎前凸角丢失值、椎间隙高度改善值和节段前凸角改善值与融合器沉降关联最紧密,临床医生应多加关注。

BACKGROUND:With the continuous advancement of medical technology,the combination of oblique lumbar interbody fusion and percutaneous pedicle screw fixation has become a common method for treating lumbar degenerative diseases;however,there is still a lack of in-depth research on the relationship between changes in anterior convexity angles at different postoperative segments and fusion device settlement.OBJECTIVE:To explore the relationship between changes in anterior convexity angle of different segments and Cage subsidence after oblique lumbar interbody fusion combined with percutaneous pedicle screw fixation surgery.METHODS:Patients(93 cases)with lumbar degenerative diseases who underwent oblique lumbar interbody fusion combined with percutaneous pedicle screw fixation surgery in Weifang Hospital of Traditional Chinese Medicine from February 2019 to April 2023 were selected as the research subjects.According to the postoperative disc height loss value,they were divided into Cage subsidence group(25 cases,≥2 mm)and non-Cage subsidence group(68 cases,<2 mm).Multiple Logistic regression analysis was used to analyze the risk factors for cage subsidence.Stepwise regression was utilized to evaluate the relationship of each risk factor and Cage subsidence.Risk prediction model was built and evaluated.RESULTS AND CONCLUSION:(1)After adjusting for confounding factors,there was still independent correlation between lumbar lordosis loss value and segmental lordosis improvement value and Cage subsidence risk(P<0.05).(2)Age,oswestry disability index,disc height improvement value,segmental lordosis improvement value,and lumbar lordosis loss value were all independent influencing factors for the occurrence of Cage subsidence(P<0.05).Among them,age,lumbar lordosis loss value,disc height improvement value,and segmental lordosis improvement value were most closely related to Cage subsidence.(3)The results of multivariate Logistic regression model analysis showed that when P=0.80,the Jordan index was the highest and the prediction effect was the best,with accuracy of 89.27%,sensitivity of 86.67%,and specificity of 89.89%.The model evaluation results showed that it had good discrimination and high accuracy.(4)As the lumbar lordosis loss value and segmental lordosis improvement value increase,the risk of Cage subsidence increases,which affects clinical efficacy.(5)It is indicated that age,lumbar lordosis loss value,disc height improvement value,and segmental lordosis improvement value are most closely related to Cage subsidence,and clinical doctors should pay more attention.