Rosen David S, Ferguson Sherise D, Ogden Alfred T, Huo Dezheng, Fessler Richard G
Section of Neurosurgery, Department of Surgery, University of Chicago Medical Center and Pritzker School of Medicine, Chicago, Illinois, USA.
Neurosurgery. 2008 Nov;63(5):956-60; discussion 960. doi: 10.1227/01.NEU.0000313626.23194.3F.
Many patients undergoing lumbar spine fusion are overweight or obese. The relationship between body habitus and outcome after lumbar spine fusion surgery is not well defined.
We analyzed a prospectively maintained database of self-reported pain and quality of life measures, including Visual Analog Scale pain score, Short Form 36, and Oswestry Disability Index. We selected patients undergoing minimally invasive transforaminal lumbar interbody fusion between September 2002 and June 2006 at a single institution. We used linear regression models and mixed-effects linear models to examine the relationships between body habitus and self-reported outcomes.
The analysis identified 110 patients meeting the study criteria, with a median follow-up period of 14.8 months. The mean age was 56 years, mean height was 169 cm, and mean weight was 82.2 kg. The mean body mass index (BMI) was 28.7 kg/m2; 31% of patients were overweight (BMI, 25-29.9), and 32% of patients were obese (BMI, >30). Linear regression analysis did not identify a correlation between weight or BMI and pre- and postsurgery changes in any of the outcome measures. The significant findings observed in the mixed-effects linear models were that the changing patterns of Short Form 36 Body Pain subscale and Short Form 36 Vitality subscale varied significantly by category of BMI (P = 0.01 and P = 0.002, respectively), but not significantly if continuous BMI was used (P = 0.53 and P = 0.46, respectively). BMI correlated marginally with estimated blood loss (P = 0.08), but not operative time, length of hospital stay, or complications.
Among this cohort of minimally invasive lumbar fusion patients, body habitus measured by BMI, weight, or height did not have a significant relationship with most self-reported outcome measures, operative time, length of hospital stay, or complications. Obesity should not be considered a contraindication to minimally invasive lumbar spinal fusion surgery.
许多接受腰椎融合手术的患者超重或肥胖。身体形态与腰椎融合手术后的结果之间的关系尚不明确。
我们分析了一个前瞻性维护的自我报告疼痛和生活质量测量数据库，包括视觉模拟量表疼痛评分、简短健康调查问卷36项（Short Form 36）和奥斯维斯特里残疾指数。我们选择了2002年9月至2006年6月在单一机构接受微创经椎间孔腰椎椎间融合术的患者。我们使用线性回归模型和混合效应线性模型来研究身体形态与自我报告结果之间的关系。
分析确定了110名符合研究标准的患者，中位随访期为14.8个月。平均年龄为56岁，平均身高为169厘米，平均体重为82.2千克。平均体重指数（BMI）为28.7千克/平方米；31%的患者超重（BMI，25 - 29.9），32%的患者肥胖（BMI，>30）。线性回归分析未发现体重或BMI与任何结果测量指标的术前和术后变化之间存在相关性。在混合效应线性模型中观察到的显著发现是，简短健康调查问卷36项身体疼痛分量表和简短健康调查问卷36项活力分量表的变化模式在BMI类别之间有显著差异（分别为P = 0.01和P = 0.002），但如果使用连续的BMI则无显著差异（分别为P = 0.53和P = 0.46）。BMI与估计失血量有微弱相关性（P = 0.08），但与手术时间、住院时间或并发症无关。
在这组微创腰椎融合患者中，通过BMI、体重或身高测量的身体形态与大多数自我报告的结果测量指标、手术时间、住院时间或并发症之间没有显著关系。肥胖不应被视为微创腰椎融合手术的禁忌证。
