腰肌质量参数对腰椎融合术后早期融合器下沉的预测价值

Predictive Value of Psoas Muscle Parameters for Early Cage Subsidence after Lumbar Fusion

目的评估基于磁共振成像(MRI)的腰肌质量参数对腰椎后路椎间融合术(PLIF)后融合器下沉的预测价值。方法对2019年2月至2023年2月接受单节段PLIF的165例病人进行回顾性研究,男75例,女90例,年龄为(65.02±8.55)岁。随访12个月以上,45例(27.3%)发生融合器沉降,根据是否发生术后融合器沉降分为沉降组(45例)与非沉降组(120例)。术前在MRI上测量腰肌指数(PMI)和腰肌质量评分(Goutallier分级),以及椎体骨质量(vertebral bone quality,VBQ)、终板骨质量(endplate bone quality,EBQ);基于CT,测量计算机断层扫描(QCT)骨密度值。比较两组病人的年龄、性别、身体质量指数(BMI)、手术节段、PMI、Goutallier分级等;采用Logistic回归分析融合器下沉的影响因素;PMI、Goutallier分级分别与融合器沉降高度、QCT骨密度值进行相关性分析;比较不同手术节段中的PMI、Goutallier分级;绘制受试者工作特征曲线(ROC),计算各预测因子的曲线下面积(AUC)。结果沉降组与非沉降组的年龄、性别、BMI、Goutallier分级、PMI、VBQ、EBQ比较,差异有统计学意义(P<0.05)。Logistic回归分析结果显示年龄、性别、QCT骨密度值、VBQ、PMI、Goutallier分级是融合器沉降的影响因素。相关性分析结果显示PMI与融合器沉降高度呈显著负相关(r=-0.402,P<0.05),与QCT骨密度值呈显著正相关(r=3.390,P<0.05);Goutallier分级与融合器沉降高度呈正相关(r=0.289,P<0.05),与QCT骨密度值呈负相关(r=-0.286,P<0.05),与PMI呈负相关(r=-0.462,P<0.05)。PMI的AUC为0.826(95%CI:0.756,0.896),最佳沉降边界为6.94 cm^(2)/m^(2),Goutallier分级的AUC为0.786(95%CI:0.719,0.854),最佳沉降边界1.5级。结论PMI和Goutallier分级可能是PLIF术后融合器沉降的重要预测指标。

Objective To evaluate the predictive value of magnetic resonance imaging(MRI)-based psoas muscle index(PMI)for cage subsidence after posterior lumbar interbody fusion(PLIF).Methods A retrospective study was performed on 165 patients who underwent single-segment PLIF from February 2019 to February 2023,including 75 males and 90 females,aged(65.02±8.55)years.A total of 45 cases(27.3%)were found to have cage subsidence during the follow-up of more than 12 months,and were divided into subsidence group(45 cases)and non-subsidence group(120 cases)according to the occurrence of postoperative cage subsidence.PMI,psoas quality score(Goutallier grade),vertebral bone quality(VBQ)and end plate bone quality(EBQ)were measured on MRI before operation;Computed tomography(QCT)bone mineral density(BMD)was measured based on CT.The age,gender,body mass index(BMI),operative segment,PMI and Goutallier grade were compared between the two groups.The logistic regression analysis was used to analyze the influencing factors of cage subsidence,and the correlation between PMI,Goutallier grade and cage subsidence height and QCT BMD was analyzed.PMI and Goutallier grade were compared among different surgical segments,and the receiver operating characteristic(ROC)curve was drawn to calculate the area under the curve(AUC)of each predictor.Results There were significant differences in age,gender,BMI,Goutallier grade,PMI,VBQ and EBQ between the subsidence group and the non-subsidence group(P<0.05).The results of Logistic regression analysis showed that age,gender,QCT BMD,VBQ,PMI and Goutallier grade were the influencing factors of cage subsidence.There was a significant negative correlation between PMI and cage settlement height(r=-0.402,P<0.05),and a significant positive correlation between PMI and QCT BMD(r=3.390,P<0.05).Goutallier grade was positively correlated with cage settlement height(r=0.289,P<0.05),negatively correlated with QCT BMD(r=-0.286,P<0.05),and negatively correlated with PMI(r=-0.462,P<0.05).PMI had an AUC of 0.826(95%CI:0.756,0.896)with an optimal settlement boundary of 6.94 cm^(2)/m^(2),and Goutallier grade had an AUC of 0.786(95%CI:0.719,0.854)with an optimal settlement boundary of 1.5 grades.Conclusion PMI and Goutallier grade may be important predictors of cage subsidence after PLIF.