Lenz Maximilian, Meyer Carolin, Boese Christoph Kolja, Siewe Jan, Eysel Peer, Scheyerer Max Joseph
Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Germany.
Orthop Rev (Pavia). 2018 Jul 4;10(2):7684. doi: 10.4081/or.2018.7684. eCollection 2018 Jun 14.
Previous studies have shown coherence between obesity and higher rates of complications following spinal surgery. However, there is a lack of information about the influence of obesity and the mass of outer abdominal fat (OAF) on adjacent segment instability after spinal fusion surgery. Radiographs of 194 patients with spinal fusion surgery were assessed retrospectively. Radiographs were performed after surgery during two years' follow-up and signs of adjacent segment instability were documented. Patients were classified regarding their BMI and extent of OAF was assessed using CT at the umbilical level. In 20 patients (10.3%) instability of adjacent segments occurred during followup. In this cohort mean OAF was significantly thicker (28.07 mm) compared to the patients without instability (22.39) (P=0.038). A total of 45% of patients with instability showed OAF of more than 30 mm at time of intervention compared to 10% in those without signs of instability. There exists significant correlation between the extent of OAF and development of adjacent segment instability postoperatively. Thus, weight reduction before spinal surgery could potentially decrease risk of adjacent segment instability.
以往的研究表明，肥胖与脊柱手术后较高的并发症发生率之间存在关联。然而，关于肥胖和腹部外周脂肪（OAF）量对脊柱融合手术后相邻节段不稳定的影响，目前尚缺乏相关信息。对194例行脊柱融合手术的患者的X线片进行了回顾性评估。在术后两年的随访期间拍摄X线片，并记录相邻节段不稳定的征象。根据患者的体重指数进行分类，并在脐水平使用CT评估OAF的范围。在20例患者（10.3%）的随访期间出现了相邻节段不稳定。在这一组中，与未出现不稳定的患者相比，平均OAF明显更厚（28.07mm）（22.39mm）（P=0.038）。在出现不稳定的患者中，共有45%在干预时OAF超过30mm，而在没有不稳定征象的患者中这一比例为10%。OAF的范围与术后相邻节段不稳定的发生之间存在显著相关性。因此，脊柱手术前减轻体重可能会降低相邻节段不稳定的风险。
