术后体重增加与经椎间孔腰椎融合术后复发性腰痛的相关性研究

Association between postoperative weight gain and recurrent low back pain after transforaminal lumbar interbody fusion

目的探讨经椎间孔腰椎融合术(transforaminal lumbar interbody fusion,TLIF)术后体重增加(postoperative weight gain,PWG)与术后3个月复发性腰痛(recurrent low back pain,RLBP)之间的关系。方法2020年9月~2022年9月因腰椎间盘突出行TLIF手术并成功随访至术后3个月的病人共254例。收集病人年龄、性别、术前身高及体重、是否吸烟、术前手术节段椎间盘退变Pfirrmann分级、术前及术后7天、1个月及2个月的腰痛视觉模拟评分(visual analogue scale,VAS)等资料。对术后7天、第1、2个月腰痛VAS评分≤3分,但术后3个月VAS评分≥4分的病人定义为RLBP。术后3个月PWG分为4组:<0 kg组、0~<5 kg组、5~<10 kg组、≥10 kg组。采用多因素Logistic回归分析优势比(ORs)。结果RLBP患病率为18.50%(47例)。与PWG<0 kg组相比,PWG 5~<10 kg和≥10 kg组的患病率较高(OR分别为2.48和4.19),差异有统计学意义(P<0.05)。与PWG 0~<5 kg组相比,患病率的差异无统计学意义。多因素Logistic回归分析显示,女性、术前高体质指数和术前Pfirmann分级为严重退变是RLBP的另外3个独立危险因素。结论TLIF病人PWG是RLBP的独立危险因素之一。术后对病人进行体重干预可以降低RLBP的发生率,提高病人手术满意度。

Objective To investigate the association between recurrent low back pain(RLBP)and postoperative weight gain(PWG)after recurrent low back pain(TLIF)at three-month follow-up.Methods We analyzed 254 patients at three-month after TLIF from September 2020 to September 2022.Data such as age,gender,height and weight before surgery,smoking status,Pfirrmann grade of preoperative intervertebral disc degeneration,visual analogue scale(VAS)before surgery and 7 days,1 month and 2 months after surgery were collected.RLBP was defined for patients with low back pain with VAS score≤3 on the 7th,1st and 2nd month after surgery,but≥4 on the 3rd month after surgery.Three months after surgery,PWG was divided into 4 groups:<0 kg group,0~<5 kg group,5~<10 kg group,and≥10 kg group.Multivariate Logistic regression analysis of odds ratio(ORs).Results The prevalence of persistent RLBP was 18.5%(n=47).Compared to patients with a PWG of<0 kg,patients with a PWG of 5 kg to<10 kg and≥10 kg had a higher prevalence of RLBP(OR=2.48 and 4.19,respectively);the difference was statistically significant(P<0.05).However,no significant difference was found for patients with a PWG of 0 kg to<5 kg.In addition,Logistic regression analysis also showed female,higher preoperative body mass index(BMI)and higher preoperative Pfirrmann grade were other three independent risk factors of RLBP.Conclusion PWG in TLIF patients is one of the independent risk factors for RLBP.Postoperative weight intervention for patients can reduce the incidence of RLBP and improve patient satisfaction with the surgery.