椎体骨质量及椎旁肌变化与经椎间孔腰椎椎间融合术后邻近节段退变的相关性研究

郑俊勇; 王松; 张鑫; 肖萧; 彭松林

doi:10.12182/20240960105

椎体骨质量及椎旁肌变化与经椎间孔腰椎椎间融合术后邻近节段退变的相关性研究

Correlation of Vertebral Bone Quality and Paraspinal Muscle Changes With Adjacent Segment Degeneration After Transforaminal Lumbar Interbody Fusion Operation

摘要

摘要:
目的通过回顾性分析因腰椎退行性疾病（lumbar degenerative disease, LDD）行经椎间孔腰椎椎间融合术（transforaminal lumbar interbody fusion, TLIF）的患者，探讨椎体骨质量（vertebral bone quality, VBQ）及椎旁肌变化与TLIF术后邻近节段退变（adjacent segment degeneration, ASD）的相关性。
方法选取2016年1月–2022年12月在深圳市人民医院因LDD行TLIF手术治疗并具有完善的随访影像学资料的患者共98例，根据ASD判定标准，分为ASD组43例，N-ASD组55例，收集两组患者的基本特征，并通过术前及末次随访时的腰椎核磁共振成像测量相关参数，包括VBQ，腰大肌（psoas major, PM）、竖脊肌（erector spinae, ES）及多裂肌（multifidus, MF）的总横截面积（total cross-section area, TCSA)、功能横截面积（functional cross-section area, FCSA），计算得出相对脂肪浸润（relative fat infiltration, RFI）。运用logistic回归分析研究ASD发生的危险因素。
结果末次随访时ASD发生率为43.9%（43例），平均随访时间为（27.23±4.15）个月，两组的年龄，体质量指数（body mass index, BMI），术前骨密度（bone mineral density, BMD），术前VBQ、ΔRFI_PM、ΔRFI_ES+MF的差异有统计学意义（P<0.05）。logistic回归分析结果显示BMI〔比值比（odds ratio, OR）=1.450，95%置信区间（confidence interval, CI）：1.081～1.945，P=0.013〕、术前VBQ（OR=6.191，95%CI：1.692～22.657，P=0.006）、ΔRFI_ES+MF（OR=1.117，95%CI：1.007～1.238，P=0.037）为TLIF术后发生ASD的独立危险因素。
结论因LDD行TLIF的患者术后ASD与较高的BMI、术前VBQ和术后竖脊肌与多裂肌的相对脂肪浸润程度增加相关。因此，强调在手术过程中对椎旁肌群的保护至关重要，并且术后加强腰背部肌肉锻炼，优化骨质量和体质量管理，有利于降低术后ASD的发生风险。

Abstract:
Objective To investigate the correlation of vertebral bone quality (VBQ) and paraspinal muscle changes with adjacent segment degeneration (ASD) after transforaminal lumbar interbody fusion (TLIF) through a retrospective analysis of patients who have undergone TLIF for lumbar degenerative diseases (LDD).
Methods A total of 98 patients who underwent TLIF surgical treatment for LDD between January 2016 and December 2022 at Shenzhen People's Hospital were selected. Well-established follow-up imaging data were available for all subjects who were divided into two groups, the ASD group (n=43) and the non-ASD (N-ASD) group (n=55), according to whether they met the ASD evaluation criteria. Data on the basic characteristics of the patients in both groups were collected, and the relevant parameters, including VBQ and the total cross-sectional area (TCSA) and the functional cross-sectional area (FCSA) of psoas major (PM), erector spinae (ES), and multifidus (MF), were measured by magnetic resonance imaging of the lumbar spine performed preoperatively and at the last follow-up. Then, the relative fat infiltration (RFI) was calculated from the above metrics accordingly. Logistic regression analysis was conducted to investigate the risk factors for ASD.
Results The incidence of ASD was 43.9% (n=43) at the final follow-up. The mean follow-up time was (27.23±4.15) months. The age, body mass index (BMI), preoperative bone mineral density (BMD), preoperative VBQ, ΔRFI_PM, and ΔRFI_ES+MF showed significant differences between the ASD and N-ASD groups (P<0.05). According to the results of the logistic regression analysis, BMI (odds ratio OR=1.450, 95% confidence interval CI: 1.081-1.945, P=0.013), preoperative VBQ (OR=6.191, 95% CI: 1.692-22.657, P=0.006), and ΔRFI_ES+MF(OR=1.117, 95% CI: 1.007-1.238, P=0.037) were independent risk factors for ASD.
Conclusion The incidence of postoperative ASD in patients who have undergone TLIF for LDD was found to be associated with higher BMI, preoperative VBQ, and increased postoperative relative fat infiltration of the ES and MF muscles. Consequently, it is advisable to prioritize the intraoperative protection of the paraspinal muscles during TLIF. In the postoperative period, it is essential to strengthen exercises of the lower back muscles and to optimize bone mass and weight management, which is conducive to reducing the risk of ASD in the postoperative period.

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