肥胖对腰椎管狭窄症后路椎间融合术的影响

Effect of obesity on posterior lumbar interbody fusion for degenerative lumbar spinal stenosis

摘要:

［目的］探讨肥胖对退行性腰椎管狭窄症（degenerative lumbar spinal stenosis, DLSS）后路椎间融合术（posterior lum- bar interbody fusion, PLIF） 的影响。［方法］ 回顾性分析 2017 年 1 月—2019 年 12 月行 PLIF 治疗的 124 例 DLSS 患者，依据术前患者 BMI 分为两组，其中肥胖组（BMI≥28.0 kg/m2 ）42 例，非肥胖组（BMI<28 kg/m2 ）82 例，比较两组围手术期、随访及影像资料。［结果］ 两组患者均顺利完成手术。非肥胖组患者手术时间、切口长度、术中出血量、术后引流量、术后下地时间、 切口愈合时间、切口并发症发生率均显著优于肥胖组（P<0.05）。患者均获得 16~25 个月随访，平均随访时间（19.58±2.71）个月，随时间推移，两组患者 VAS 评分、ODI 指数均显著降低（P<0.05）。但相应时间点两组间 VAS 评分、ODI 指数差异均无统计学意义（P>0.05）。影像学方面，与术前相比，术后 3 个月及末次随访时两组患者椎间隙高度均显著增加（P<0.05）。至末次随访时，两组椎间融合 BSF 分级差异无统计学意义 （P>0.05），但肥胖组邻椎退变率高于非肥胖组 （16.67% vs 4.88%，P< 0.05）。［结论］肥胖增加了 DLSS 患者 PLIF 治疗的术中出血量、切口并发症发生率及邻椎退变风险。

Abstract:

[Objective] To explore the effect of obesity on posterior lumbar interbody fusion (PLIF) for degenerative lumbar spinal ste- nosis (DLSS) . [Methods] A retrospective study was conducted on a total of 124 patients who underwent PLIF for DLSS in our hospital from January 2017 to December 2019. According to the preoperative BMI, 42 patients who had BMI ≥28.0 kg/m2 were fall into the obese group, while the remained 82 patients who had BMI＜28 kg/m2 were enrolled into the non-obese group. The documents regarding to perioperative period, follow-up and radiographs were compared between the two groups. [Results] All patients had operation completed successfully. The non-obese group was significantly superior to the obese group in terms of operation time, incision length, intraoperative blood loss, postoper- ative drainage, time to resume walking, time to remove stitches and incidence of incision complications (P＜0.05) . All patients were fol- lowed up for 16~25 months, with an average of (19.58±2.71) months. The VAS score and ODI index of the two groups were significantly im- proved over time. However, there was no significant difference in VAS score and ODI index between the two groups at any corresponding time point (P＞0.05) . With respect of imaging, the disc height significantly increased at the last follow-up and 3 months after operation in both groups compared with those before operation (P＜0.05) . At the last follow-up, there was no significant difference in interbody fusion in term of BSF classification between the two groups (P＞0.05) , but the degeneration rate of adjacent vertebrae in the obese group was higher than that in the non-obese group (16.67% vs 4.88%, P＜0.05) . [Conclusion] Obesity increases the intraoperative bleeding, the incidence of incision complications and the risk of adjacent vertebral degeneration in PLIF for DLSS.