Ushirozako Hiroki, Hasegawa Tomohiko, Ebata Shigeto, Ohba Tetsuro, Oba Hiroki, Mukaiyama Keijiro, Shimizu Satoshi, Yamato Yu, Ide Koichiro, Shibata Yosuke, Ojima Toshiyuki, Takahashi Jun, Haro Hirotaka, Matsuyama Yukihiro
Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Department of Orthopedic Surgery, International University of Health and Welfare, Narita, Chiba, Japan.
Global Spine J. 2022 Apr;12(3):399-408. doi: 10.1177/2192568220953813. Epub 2020 Sep 10.
Retrospective cohort study.
Nonunion after posterior lumbar interbody fusion (PLIF) is associated with poor improvements in health-related quality of life (HRQOL). We aimed to investigate the influence of early osseous union after PLIF on HRQOL.
We reviewed 138 patients with 1-level PLIF (mean age 67 years, follow-up period ≥1 year). Postoperative lumbar computed tomography was performed to assess screw loosening and intervertebral union. HRQOL was assessed using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire.
Thirty-nine patients (28%) showed complete union at 6 months postoperatively (early union group). Twenty-eight patients (20%) showed complete union at 6 to 12 months postoperatively (delayed union group), while 71 patients demonstrated noncomplete union. Effective improvement of lumbar spine dysfunction and psychological disorders was achieved in 19 (63.3%) and 17 (50.0%) patients in the early union group, in 9 (42.9%) and 14 (53.8%) patients in the delayed union group, and in 22 (34.9%) and 19 (29.2%) patients in the nonunion group, respectively ( = .036 and = .036, respectively). The nonunion group had a significantly higher proportion of cases with screw loosening at 6 and 12 months postoperatively than the complete union group ( = .033 and = .022).
Lumbar spine dysfunction and psychological disorders improved in cases with early complete union compared to those with nonunion. Screw loosening occurred in cases with nonunion predominantly from 6 months postoperatively. Therefore, the achievement of early complete union might be helpful for better HRQOL and lower incidence of postoperative complications.
回顾性队列研究。
腰椎后路椎间融合术（PLIF）后骨不连与健康相关生活质量（HRQOL）改善不佳相关。我们旨在研究PLIF术后早期骨愈合对HRQOL的影响。
我们回顾了138例行单节段PLIF的患者（平均年龄67岁，随访期≥1年）。术后行腰椎计算机断层扫描以评估螺钉松动和椎间融合情况。使用日本骨科协会背痛评估问卷对HRQOL进行评估。
39例患者（28%）术后6个月显示完全融合（早期融合组）。28例患者（20%）术后6至12个月显示完全融合（延迟融合组），而71例患者显示未完全融合。早期融合组分别有19例（63.3%）和17例（50.0%）患者的腰椎功能障碍和心理障碍得到有效改善，延迟融合组分别有9例（42.9%）和14例（53.8%）患者，未融合组分别有22例（34.9%）和19例（29.2%）患者（分别为P = 0.036和P = 0.036）。未融合组术后6个月和12个月螺钉松动的病例比例显著高于完全融合组（P = 0.033和P = 0.022）。
与未融合的病例相比，早期完全融合的病例中腰椎功能障碍和心理障碍有所改善。未融合病例中螺钉松动主要发生在术后6个月以后。因此，实现早期完全融合可能有助于改善HRQOL并降低术后并发症的发生率。
