**标题**： 单节段微创经椎间孔腰椎体间融合术后 5 年随访：体重指数对功能结局、满意度和重返工作的影响 **摘要**：目的：探讨单节段微创经椎间孔腰椎体间融合术（TLIF）治疗腰椎退行性疾病患者的长期临床疗效。方法：回顾性分析 2014 年 1 月至 2016 年 12 月在我院接受单节段微创 TLIF 治疗的 60 例腰椎退行性疾病患者的临床资料。所有患者均采用经皮椎弓根螺钉内固定联合椎间融合器植骨融合术。结果：患者均获得 5 年随访，平均年龄为 57.3 岁（范围：33-76 岁）。术前、术后及末次随访时的视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）、日本骨科协会（JOA）评分均显著改善（P<0.05）。末次随访时，优 36 例，良 20 例，可 4 例，优良率为 93.3%。末次随访时，所有患者均未出现内固定松动、断裂或融合器移位等并发症。术后 1 年、3 年、5 年的融合率分别为 96.7%、98.3%、98.3%。术后 1 年、3 年、5 年的 BMI 与末次随访时的 VAS、ODI 及 JOA 评分均无相关性（P>0.05）。结论：单节段微创 TLIF 治疗腰椎退行性疾病患者的短期及中期疗效满意，长期疗效确切。
The Influence of Body Mass Index on Functional Outcomes, Satisfaction, and Return to Work After Single-level Minimally-invasive Transforaminal Lumbar Interbody Fusion: A Five-year Follow-up Study.
机构信息
Department of Orthopedic Surgery, Singapore General Hospital, Singapore.
The Orthopaedic Centre, Mount Elizabeth Medical Centre, Singapore.
出版信息
Spine (Phila Pa 1976). 2019 Jun 1;44(11):809-817. doi: 10.1097/BRS.0000000000002943.
STUDY DESIGN
Retrospective study using prospectively collected registry data.
OBJECTIVES
To evaluate the effect of obesity on patient-reported outcome measures of pain, disability, quality of life, satisfaction, and return to work after single-level minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).
SUMMARY OF BACKGROUND DATA
MIS-TLIF is an appealing alternative for obese patients with potentially lower complication risk. However, there is limited data investigating the influence of obesity on outcomes 5 years after MIS-TLIF.
METHODS
Prospectively collected registry data of 296 patients who underwent single-level MIS-TLIF at a single institution were reviewed. Patients had complete 2- and 5-year follow-up data. Patients were stratified into control (<25.0 kg/m), overweight (25.0-29.9 kg/m), and obese (≥30.0 kg/m) groups. Outcomes assessed were visual analogue scale for back pain, leg pain, Oswestry Disability Index, Short-form 36, North American Spine Society score for neurogenic symptoms, return to work (RTW), return to function (RTF), satisfaction, and expectation fulfilment. Length of operation, length of stay, and comorbidities were recorded.
RESULTS
Among the patients, 156 (52.7%) had normal weight, 108 (36.5%) were overweight, and 32 (10.8%) were obese. There was no difference in length of operation or hospitalization (P > 0.05). All three groups had comparable preoperative scores at baseline (P > 0.05). At 5 years, the control group had significantly higher PCS compared with the overweight (P = 0.043) and obese groups (P = 0.007), although the change in scores was similar (P > 0.05). The rate of MCID attainment, RTW, RTF, expectation fulfilment, and satisfaction was comparable.
CONCLUSION
Nonobese patients had better physical well-being in the mid-term, although obese patients experienced a comparable improvement in clinical scores. Obesity had no impact on patients' ability to RTW or RTF. Equivalent proportions of patients were satisfied and had their expectations fulfilled up to 5 years after MIS-TLIF.
LEVEL OF EVIDENCE
研究设计
使用前瞻性收集的登记数据进行回顾性研究。
目的
评估肥胖对单节段微创经椎间孔腰椎体间融合术（MIS-TLIF）后患者报告的疼痛、残疾、生活质量、满意度和重返工作的结果测量指标的影响。
背景资料概要
MIS-TLIF 是肥胖患者的一种有吸引力的选择，因为其潜在的并发症风险较低。然而，关于肥胖对 MIS-TLIF 后 5 年结果的影响，数据有限。
方法
对一家单机构行单节段 MIS-TLIF 的 296 例患者的前瞻性收集的登记数据进行了回顾性分析。患者有完整的 2 年和 5 年随访数据。患者分为对照组（<25.0kg/m2）、超重组（25.0-29.9kg/m2）和肥胖组（≥30.0kg/m2）。评估的结果包括视觉模拟评分（VAS）用于背痛、腿痛、Oswestry 残疾指数、简短形式 36 项健康调查量表、北美脊柱学会神经症状评分、重返工作（RTW）、重返功能（RTF）、满意度和期望满足度。记录手术时间、住院时间和合并症。
结果
在患者中，156 例（52.7%）体重正常，108 例（36.5%）超重，32 例（10.8%）肥胖。手术时间和住院时间无差异（P>0.05）。三组患者基线时的术前评分均相似（P>0.05）。在 5 年时，对照组的 PCS 明显高于超重组（P=0.043）和肥胖组（P=0.007），尽管评分的变化相似（P>0.05）。达到 MCID 的比例、RTW、RTF、期望满足度和满意度相当。
结论
非肥胖患者在中期有更好的身体舒适度，尽管肥胖患者在临床评分方面也有类似的改善。肥胖对患者重返工作或重返功能的能力没有影响。在 MIS-TLIF 后长达 5 年，相当比例的患者满意并实现了他们的期望。
证据水平
3 级。
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