Department of Neurological Surgery, Weill Cornell Medical College, NY-Presbyterian Hospital, 525 E. 68th St., New York, NY 10021, USA.
Spine (Phila Pa 1976). 2009 Aug 15;34(18):E664-72. doi: 10.1097/BRS.0b013e3181b0b63d.
This is a retrospective single-center case study involving 115 obese and nonobese patients who underwent minimally invasive lumbar surgery between 2004 and 2007.
The purpose of this study was to evaluate the effect of minimally invasive spinal surgery in obese and nonobese patients by operative results and patient outcomes.
Spinal surgery in obese patients is associated with increased complications, blood loss, and operative times. The potential benefits of minimally invasive lumbar surgery in obese patients are discussed.
All patients underwent 1-level lumbar microdiscectomy or laminectomy using tubular retractors. Data were collected on patient demographics, comorbidities, smoking habits, operative results, and clinical outcomes, and compared for obese and nonobese patients. Operative results included operative times, blood loss, length of stay, and perioperative complications. Clinical outcomes were assessed by using pre- and postoperative visual analog scale and Macnab outcome criteria at most recent follow-up.
In this study, 31% of 115 patients were classified as obese. Obese patients tended to undergo surgery at a younger age. Obesity, comorbidities, and age did not have an impact on patient outcome at a mean follow-up of 15.9 months. No significant differences were seen between obese versus nonobese patients in terms of incision lengths, operative time, blood loss, and complication rates. In obese patients, all parameters and operative results compared favorably to reported historical results of patients undergoing open lumbar surgery. Overall, favorable outcome was seen in 92% and 84% of obese and nonobese lumbar microdiscectomy patients, respectively, and in 75% of laminectomy patients. Postoperative visual analog scale did not show any significant difference.
This is the first study comparing operative results from tubular microsurgery between obese and nonobese patients. No major differences were detected in outcome, operative and perioperative data including complication rates. With tubular microsurgery, obese patients experienced the same or equally beneficial outcome, compared to nonobese patients, while incision lengths, blood loss, operative times, and length of stay were less when compared to open procedures. Other comorbidities and age had no significant impact on perioperative complications and clinical outcome.
这是一项回顾性的单中心病例研究，涉及 2004 年至 2007 年间接受微创腰椎手术的 115 例肥胖和非肥胖患者。
本研究旨在通过手术结果和患者预后评估微创脊柱手术对肥胖和非肥胖患者的疗效。
肥胖患者的脊柱手术与并发症、出血量和手术时间增加有关。讨论了微创腰椎手术在肥胖患者中的潜在益处。
所有患者均采用管状牵开器行 1 节段腰椎显微切除术或椎板切除术。收集患者的人口统计学、合并症、吸烟习惯、手术结果和临床结果，并对肥胖和非肥胖患者进行比较。手术结果包括手术时间、出血量、住院时间和围手术期并发症。通过术前和术后视觉模拟评分和末次随访时 Macnab 结果标准评估临床结果。
本研究中，115 例患者中有 31%为肥胖。肥胖患者的手术年龄往往较小。肥胖、合并症和年龄对平均随访 15.9 个月的患者预后无影响。肥胖患者与非肥胖患者在切口长度、手术时间、出血量和并发症发生率方面无显著差异。在肥胖患者中，所有参数和手术结果与接受开放式腰椎手术的患者的历史结果相比均表现良好。总体而言，肥胖腰椎显微切除术患者的优良率分别为 92%和 84%，而椎板切除术患者的优良率为 75%。术后视觉模拟评分无显著差异。
这是第一项比较肥胖和非肥胖患者管状微创手术手术结果的研究。在预后、手术和围手术期数据（包括并发症发生率）方面未发现明显差异。与开放式手术相比，管状微创手术使肥胖患者获得相同或同等的有益结果，同时切口长度、出血量、手术时间和住院时间减少。其他合并症和年龄对围手术期并发症和临床预后无显著影响。
