| 椎旁肌退变与短节段腰椎融合内固定术后螺钉松动的相关性分析 |
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| 引用本文： | 廖培基,蔡东岭,郭伟俊,陈晓峰,魏其鹏,范宇澄.椎旁肌退变与短节段腰椎融合内固定术后螺钉松动的相关性分析[J].现代生物医学进展,2023(21):4065-4070. |
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| 作者姓名： | 廖培基 蔡东岭 郭伟俊 陈晓峰 魏其鹏 范宇澄 |
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| 作者单位： | 广州中医药大学 广东 广州 510006;广州市番禺区中医院脊柱外科 广东 广州 511400 |
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| 基金项目： | 广州市番禺区科技计划重大医疗卫生项目重点学科项目（2022-Z04-112）；广州市中医药和中西医结合科技项目（20222A010078）；广东省中医药局面上科研项目（20191262） |
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| 摘 要： | 摘要 目的：分析椎旁肌退变与短节段腰椎融合内固定术后螺钉松动的相关性。方法：回顾性分析2018年6月至2020年6月广州市番禺区中医院行短节段腰椎融合内固定术治疗的251例腰椎退行性疾病患者的临床资料，根据术后螺钉松动情况分为松动组（n=47）和对照组（n=204）。收集患者的临床资料，对比两组椎间植骨融合情况、螺钉直径、螺钉长度、螺钉椎内长度、椎旁肌的肌肉相对总横截面积（rtCSA）和脂肪浸润程度（FI）。应用多因素logistic回归分析短节段腰椎融合内固定术后螺钉松动发生的危险因素，并描绘受试者工作特征（ROC）曲线检验危险因素预测短节段腰椎融合内固定术后螺钉松动的效能。结果：251例患者平均随访时间（24.16±7.28）个月，其中47例患者在最终随访时发生螺钉松动，总体松动率18.73%。两组性别、骨密度比较差异有统计学意义（P＜0.05）。与对照组相比，松动组的多裂肌FI增高（P＜0.05）。与对照组相比，松动组的竖脊肌rtCSA减少，竖脊肌FI增高（P＜0.05）。多因素logistic回归分析显示竖脊肌FI较高是短节段腰椎融合内固定术后螺钉松动发生的独立危险因素，而竖脊肌rtCSA较高、骨密度较高则是保护因素（P＜0.05）。ROC曲线分析显示：骨密度、竖脊肌rtCSA、竖脊肌FI等3指标单独及联合应用时：ROC-AUC（0.95CI）分别为0.708（0.446～0.971）、0.736（0.495～0.951）、0.648（0.335～0.965）、0.842（0.719～0.957）。联合应用预测效能较高。结论：竖脊肌的退变是短节段腰椎融合内固定术后螺钉松动的危险因素。当骨密度＜-3.00 g/cm2、竖脊肌rtCSA＜1.45%及FI＞35.00%时，提示术后发生螺钉松动的可能性大，可作为短节段腰椎融合内固定术后评价螺钉松动风险的参考指标。
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| 关 键 词： | 椎旁肌 椎弓根螺钉松动 腰椎融合内固定术 影响因素 预测效能 |
| 收稿时间： | 2023/5/8 0:00:00 |
| 修稿时间： | 2023/5/31 0:00:00 |
Correlation Analysis between Paravertebral Muscle Degeneration and Screw Loosening after Short Segment Lumbar Fusion Internal Fixation Surgery |
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| Abstract: | ABSTRACT Objective: Analysis of the correlation between paravertebral muscle degeneration and screw loosening after short segment lumbar fusion internal fixation surgery. Methods: Retrospective analysis of clinical data of 251 patients with lumbar degenerative diseases who underwent short segment lumbar fusion internal fixation surgery at Guangzhou Panyu District Traditional Chinese Medicine Hospital from June 2018 to June 2020, they were divide into the loosening group (n=47) and the control group (n=204) based on postoperative screw loosening. Collect clinical data of patients, Compare the intervertebral bone graft fusion, screw diameter, screw length, screw intravertebral length, relative total cross-sectional area (rtCSA) of the paravertebral muscle, and fat infiltration (FI) between two groups. Multivariate logistic regression analysis was used to determine the risk factors for screw loosening after short segment lumbar fusion internal fixation surgery, and the receiver operating characteristic (ROC) curve was drawn to test the efficacy of risk factors in predicted screw loosening after short segment lumbar fusion internal fixation surgery. Results: The average follow-up time of 251 patients was (24.16±7.28) months, of which 47 cases had screw loosening at the final follow-up, with an overall loosening rate of 18.73%. There were significant differences in gender and bone mineral density between the two groups(P<0.05). Compared with the control group, The FI of multifidus in the loosening group was increased(P<0.05). Compared with the control group, the loosening group showed showed a decrease in rtCSA of erector spinae and an increase in FI of erector spinae (P<0.05). Multivariate logistic regression analysis showed that higher FI of erector spinae were risk factors for screw loosening after short segment lumbar fusion internal fixation surgery, while the higher rtCSA of erector spinae and higher bone mineral density were protective factors(P>0.05). ROC curve analysis showed that when used alone or in combination, the ROC-AUC (0.95CI) of bone mineral density, erector spinae rtCSA, and erector spinae FI were 0.708 (0.446~0.971), 0.736 (0.495~0.951), 0.648 (0.335~0.965) and 0.842 (0.719~0.957), respectivel, Predicted higher efficacy in combination. Conclusion: Degeneration of the erector spinae is one of the risk factors for screw loosening after short segment lumbar fusion internal fixation surgery, When the bone mineral density is less than -3.00 g/cm2, erector spinae rtCSA is less than 1.45%, and FI is greater than 35.00%, it indicates a high possibility of postoperative screw loosening, can serve as a reference indicator for evaluating the risk of screw loosening after short segment lumbar fusion internal fixation surgery. |
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| Keywords: | Paravertebral muscle Pedicle screw loosening Short segment lumbar fusion internal fixation Influence factors Predicted efficacy |
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