不同BMI单节段腰椎退行性病变患者经腰椎后路360°融合术治疗效果及预后对比
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摘要
目的对比分析不同体质量指数(BMI)单节段腰椎退行性病变患者经腰椎后路360°融合术治疗效果及预后。方法选取中日友好医院2013年1月—2017年11月期间收治的216例单节段腰椎退行性病变患者根据BMI不同分为正常组(84例,BMI<24 kg/m~2),超重组(80例,24 kg/m~2≤BMI<28 kg/m~2),肥胖组(52例,BMI≥28 kg/m~2)。均接受经腰椎后路360°融合术治疗,获取3组手术相关数据及术前、术后各随访时间点日本骨科学会腰痛疾患评定表(JOA)、Oswestry功能障碍指数评价系统(ODI)评分结果。结果术中出血量、术后引流量比较,正常组<超重组<肥胖组;手术时间、术后住院时间比较,正常组<超重组<肥胖组;伤口并发症发生率比较,正常组<超重组<肥胖组;各组上述指标差异均有统计学意义(均P<0.05)。3组术后各随访时间点JOA评分、ODI评分均较术前显著改善(均P<0.05),且术后1、3个月JOA评分、ODI评分改善效果对比差异无统计学意义(均P>0.05),但术后6、12个月正常组、超重组JOA评分明显高于肥胖组,ODI评分明显低于肥胖组,差异均有统计学意义(均P<0.05)。结论经腰椎后路360°融合术治疗单节段腰椎退行性病变可取得较好的治疗效果,但超重或肥胖者术中出血量、术后引流量更多,手术时间、术后住院时间更长,伤口并发症发生率更高,尤其是肥胖患者预后相对较差。
Objective To compare the curative effect and prognosis of patients with single segment lumbar degenerative disease of different body mass index(BMI) undergoing posterolateral spinal 360° fusion. Methods A total of 216 patients with single segment lumbar degenerative disease admitted to the hospital from January 2013 to November 2017 were divided into normal group(84 cases, BMI less than 24 kg/m~2), overweight group(80 cases, 24 kg/m~2 not less than BMI less than 28 kg/m~2) and obesity group(52 cases, BMI not less than 28 kg/m~2) according to different BMI. All patients underwent posterolateral spinal 360° fusion. The surgery-related data, the scores of Japanese orthopaedic association's low back pain assessment(JOA) and oswestry disability index evaluation system(ODI) at each follow-up time before and after surgery of the three groups were obtained. Results Arranging the intraoperative blood loss and postoperative drainage from small to large, the corresponding order was normal group, overweight group and obesity group. Arranging the operation time and postoperative hospital stay from short to long, the corresponding order was normal group, overweight group and obesity group. Arranging the incidence of wound complication from low to high, the corresponding order was normal group, overweight group and obesity group. The above indicators in each group were statistically significant(all P<0.05). The JOA score and ODI score of the three groups at each follow-up time after surgery were significantly improved compared with those before surgery(all P<0.05). There was no significant difference in the improvement of JOA score and ODI score between 1 month and 3 months after surgery(all P>0.05). The JOA scores in the normal group and overweight group were significantly higher than those in the obesity group at 6 months and 12 months after surgery, while the ODI score was significantly lower than that in the obesity group(all P<0.05). Conclusion Posterolateral spinal 360° fusion in the treatment of single segment lumbar degenerative disease can achieve good curative effect. The intraoperative blood loss and postoperative drainage are more in overweight or obese patients. The operation time and postoperative hospital stay are longer. And the incidence of wound complications is higher. Especially, the prognosis in obese patients is relatively poorer.
Objective To compare the curative effect and prognosis of patients with single segment lumbar degenerative disease of different body mass index(BMI) undergoing posterolateral spinal 360° fusion. Methods A total of 216 patients with single segment lumbar degenerative disease admitted to the hospital from January 2013 to November 2017 were divided into normal group(84 cases, BMI less than 24 kg/m~2), overweight group(80 cases, 24 kg/m~2 not less than BMI less than 28 kg/m~2) and obesity group(52 cases, BMI not less than 28 kg/m~2) according to different BMI. All patients underwent posterolateral spinal 360° fusion. The surgery-related data, the scores of Japanese orthopaedic association's low back pain assessment(JOA) and oswestry disability index evaluation system(ODI) at each follow-up time before and after surgery of the three groups were obtained. Results Arranging the intraoperative blood loss and postoperative drainage from small to large, the corresponding order was normal group, overweight group and obesity group. Arranging the operation time and postoperative hospital stay from short to long, the corresponding order was normal group, overweight group and obesity group. Arranging the incidence of wound complication from low to high, the corresponding order was normal group, overweight group and obesity group. The above indicators in each group were statistically significant(all P<0.05). The JOA score and ODI score of the three groups at each follow-up time after surgery were significantly improved compared with those before surgery(all P<0.05). There was no significant difference in the improvement of JOA score and ODI score between 1 month and 3 months after surgery(all P>0.05). The JOA scores in the normal group and overweight group were significantly higher than those in the obesity group at 6 months and 12 months after surgery, while the ODI score was significantly lower than that in the obesity group(all P<0.05). Conclusion Posterolateral spinal 360° fusion in the treatment of single segment lumbar degenerative disease can achieve good curative effect. The intraoperative blood loss and postoperative drainage are more in overweight or obese patients. The operation time and postoperative hospital stay are longer. And the incidence of wound complications is higher. Especially, the prognosis in obese patients is relatively poorer.
引文
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[10] BURNS J W,QUARTANA P J,BRUEHL S,et al.Chronic pain,body mass index and cardiovascular disease risk factors:tests of moderation,unique and shared relationships in the Study of Women's Health Across the Nation (SWAN)[J].J Behav Med,2015,38(2):372-383.
[11] SMUCK M,KAO M C,BRAR N,et al.Does physical activity influence the relationship between low back pain and obesity?[J].Spine J,2014,14(2):209-216.
[12] VARSANO N,FARGION I,WOLF S G,et al.Formation of 3D cholesterol crystals from 2D nucleation sites in lipid bilayer membranes:implications for atherosclerosis[J].J Am Chem Soc,2015,137(4):1601-1607.
[13] 张武,辛本磊,刘健,等.体质指数对腰椎小关节骨性关节炎发病及严重度分级的影响[J].中国临床研究,2016,29(10):1336-1339.
[14] 陈旭狮,宋祖坤,桑朝辉,等.腰腿痛患者腰椎间盘重度退变的危险因素[J].实用医学杂志,2016,32(23):3863-3866.
[15] MCANANY S J,PATTERSON D C,OVERLEY S,et al.The effect of obesity on the improvement in health state outcomes following minimally invasive transforaminal interbody fusion[J].Global Spine J,2016,6(8):744-748.
[16] 黄胜,罗嘉全,李亮平,等.体质量指数对后路360°融合术治疗单节段腰椎退行性疾病疗效的影响[J].中国修复重建外科杂志,2016,30(2):197-201.
[17] GOLDIN A N,ALANDER D H.Effect of body mass index on early outcomes of minimally invasive degenerative lumbar surgery[J].J Surg Orthop Adv,2015,24(1):12-17.
[18] 周升新,王英振.肥胖与腰椎间盘突出症术后腰腿痛的相关性研究[J].颈腰痛杂志,2018,39(1):41-43.
[19] NARAIN A S,HIJJI F Y,BOHL D D,et al.Is Body mass index a risk factor for revision procedures after minimally invasive transforaminal lumbar interbody fusion?[J].Clin Spine Surg,2018,31(1):e85-e91.
[2] 汪吉新,兰思恒,刘华飞,等.微创经椎间孔椎体间融合术治疗单节段Ⅰ度和Ⅱ度退行性腰椎滑脱症的疗效及安全性分析[J].中华全科医学,2018,16(6):919-921.
[3] 赵新华,袁航,钱金黔,等.后路椎体间融合术治疗复发性腰椎间盘突出症围手术期并发症及其危险因素[J].中华骨科杂志,2016,36(17):1121-1125.
[4] LEE Y H,JIN B,LEE S H,et al.Herbal formula HT048 attenuates diet-induced obesity by improving hepatic lipid metabolism and insulin resistance in obese rats[J].Molecules,2016,25(21):1424.
[5] 陈旭狮,桑朝辉,彭楷文,等.腰腿痛患者肥胖与腰椎间盘退变程度的相关性研究[J].中国骨与关节杂志,2016,5(11):868-872.
[6] 姚富华,詹新立,刘冲,等.女性腰椎退变性疾病术后慢性腰痛的危险因素分析[J].中国脊柱脊髓杂志,2017,27(12):1071-1080.
[7] FUKUI M,CHIBA K,KAWAKAMI M,et al.Japanese orthopaedic association back pain evaluation questionnaire.Part 2.verification of its reliability:the subcommittee on low back pain and cervical myelopathy evaluation of the clinical outcome committee of the Japanese orthopaedic association[J].J Orthop Sci,2007,12(6):526-532.
[8] VIANIN M.Psychometric properties and clinical usefulness of the Oswestry Disability Index[J].J Chiropr Med,2008,7(4):161-163.
[9] 高素颖,李孝华,颜应琳,等.颈围与肥胖相关指标及胰岛素抵抗相关代谢紊乱的关系研究[J].中国基层医药,2016,23(5):671-674.
[10] BURNS J W,QUARTANA P J,BRUEHL S,et al.Chronic pain,body mass index and cardiovascular disease risk factors:tests of moderation,unique and shared relationships in the Study of Women's Health Across the Nation (SWAN)[J].J Behav Med,2015,38(2):372-383.
[11] SMUCK M,KAO M C,BRAR N,et al.Does physical activity influence the relationship between low back pain and obesity?[J].Spine J,2014,14(2):209-216.
[12] VARSANO N,FARGION I,WOLF S G,et al.Formation of 3D cholesterol crystals from 2D nucleation sites in lipid bilayer membranes:implications for atherosclerosis[J].J Am Chem Soc,2015,137(4):1601-1607.
[13] 张武,辛本磊,刘健,等.体质指数对腰椎小关节骨性关节炎发病及严重度分级的影响[J].中国临床研究,2016,29(10):1336-1339.
[14] 陈旭狮,宋祖坤,桑朝辉,等.腰腿痛患者腰椎间盘重度退变的危险因素[J].实用医学杂志,2016,32(23):3863-3866.
[15] MCANANY S J,PATTERSON D C,OVERLEY S,et al.The effect of obesity on the improvement in health state outcomes following minimally invasive transforaminal interbody fusion[J].Global Spine J,2016,6(8):744-748.
[16] 黄胜,罗嘉全,李亮平,等.体质量指数对后路360°融合术治疗单节段腰椎退行性疾病疗效的影响[J].中国修复重建外科杂志,2016,30(2):197-201.
[17] GOLDIN A N,ALANDER D H.Effect of body mass index on early outcomes of minimally invasive degenerative lumbar surgery[J].J Surg Orthop Adv,2015,24(1):12-17.
[18] 周升新,王英振.肥胖与腰椎间盘突出症术后腰腿痛的相关性研究[J].颈腰痛杂志,2018,39(1):41-43.
[19] NARAIN A S,HIJJI F Y,BOHL D D,et al.Is Body mass index a risk factor for revision procedures after minimally invasive transforaminal lumbar interbody fusion?[J].Clin Spine Surg,2018,31(1):e85-e91.