Makino Takahiro, Kaito Takashi, Fujiwara Hiroyasu, Ishii Takahiro, Iwasaki Motoki, Yoshikawa Hideki, Yonenobu Kazuo
Department of Orthopedic Surgery, National Hospital Organization Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan,
J Orthop Sci. 2014 Sep;19(5):707-12. doi: 10.1007/s00776-014-0591-6. Epub 2014 Jun 12.
Although delayed union or pseudoarthrosis after lumbar arthrodesis has been recognized as a major radiographic complication, little has been known about the effect of fusion status on the patient's quality-of-life (QOL) outcome. The purpose of this study was to investigate the effects of fusion status after posterior lumbar interbody fusion (PLIF) on QOL outcomes by using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ).
Among 100 patients who underwent single level PLIF for spinal canal stenosis, 29 who had not achieved fusion (incomplete fusion group) and 29 age- and sex ratio-matched patients who had achieved fusion (fusion group) 6 months after surgery were enrolled. Overall clinical evaluation was performed before and 6 months after surgery: the physician determined the Japanese Orthopaedic Association Score for Low Back Pain (JOA score); the JOABPEQ and visual analogue scale (VAS) values were collected. The recovery rate of the JOA score, changes in all JOABPEQ subdomain scores and in the VAS values were calculated. All variables were compared between the groups.
The preoperative JOA scores, JOABPEQ scores of all subdomains, and VAS values of all categories did not differ between the groups. The recovery rate was higher in the fusion group than the incomplete fusion group (p = 0.0185). The changes in the JOABPEQ scores for walking ability and social life function were significantly greater in the fusion group than the incomplete fusion group (walking ability, p = 0.0172; social life function, p = 0.0191). The postoperative VAS values and changes in the VAS values for all categories did not differ between the groups.
Incomplete fusion after PLIF correlated with poor improvement in walking ability and social life function. Therefore, the achievement of fusion after PLIF is essential to obtain better patient QOL outcomes.
尽管腰椎融合术后延迟愈合或假关节形成已被认为是一种主要的影像学并发症，但关于融合状态对患者生活质量（QOL）结果的影响却知之甚少。本研究的目的是通过使用日本骨科学会背痛评估问卷（JOABPEQ）来调查后路腰椎椎间融合术（PLIF）后融合状态对生活质量结果的影响。
在100例行单节段PLIF治疗椎管狭窄的患者中，纳入术后6个月未实现融合的29例患者（未融合组）和29例年龄及性别比例匹配且已实现融合的患者（融合组）。在手术前和术后6个月进行全面临床评估：医生确定日本骨科学会下腰痛评分（JOA评分）；收集JOABPEQ和视觉模拟量表（VAS）值。计算JOA评分的恢复率、所有JOABPEQ子域评分的变化以及VAS值的变化。对两组间的所有变量进行比较。
两组间术前JOA评分、所有子域的JOABPEQ评分以及所有类别的VAS值均无差异。融合组的恢复率高于未融合组（p = 0.0185）。融合组行走能力和社会生活功能的JOABPEQ评分变化显著大于未融合组（行走能力，p = 0.0172；社会生活功能，p = 0.0191）。两组间术后VAS值及所有类别的VAS值变化无差异。
PLIF术后未融合与行走能力和社会生活功能改善不佳相关。因此，PLIF术后实现融合对于获得更好的患者生活质量结果至关重要。
