后路腰椎椎间融合术（PLF）与经椎间孔腰椎椎体间融合术（PLIF）及腰5-骶1的转归：对来自地区脊柱登记处的3065例行腰椎融合术患者的手术不愈合率分析

PLF Versus PLIF and the Fate of L5-S1: Analysis of Operative Nonunion Rates Among 3065 Patients with Lumbar Fusions from a Regional Spine Registry.

作者信息

Guppy Kern H, Royse Kathryn E, Norheim Elizabeth P, Harris Jessica E, Brara Harsimran S

机构信息

The Permanente Medical Group, Sacramento, CA.

Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA.

出版信息

Spine (Phila Pa 1976). 2021 May 15;46(10):E584-E593. doi: 10.1097/BRS.0000000000003840.

DOI:10.1097/BRS.0000000000003840

PMID:33306615

Abstract

STUDY DESIGN

A retrospective cohort study with chart review.

OBJECTIVE

The aim of this study was to compare the reoperation rates for symptomatic nonunions (operative nonunion rates) between posterolateral fusions with pedicle screws (PLFs) and posterior interbody fusion with pedicle screws (PLIFs).

SUMMARY OF BACKGROUND DATA

Although radiographic nonunions in PLFs and PLIFs are well documented in the literature, there is no consensus on which technique has lower nonunions. Since some radiographic nonunions may be asymptomatic, a more clinically useful measure is operative nonunions, of which there is minimal research.

METHODS

A retrospective cohort study, using data from the Kaiser Permanente Spine Registry, identified adult patients (≥18 years' old) who had elective single and multilevel PLFs and PLIFs. Descriptive statistics and 2-year incidence rates for operative nonunions were calculated by fusion-level (1-3), fusion type (PLF vs. PLIF), and levels fused (L3 to S1). Time-dependent multivariable Cox-Proportional Hazards regression was used to evaluate nonunion reoperation rates with adjustment for covariates.

RESULTS

The cohort consisted of 3065 patients with PLFs (71.6%) and PLIFs (28.4%). Average age was 65.0 ± 11.7, average follow-up time was 4.8 ± 3.1 years, and average time to operative nonunion was 1.6 (±1.3) years. Single and multilevel incidence rates for nonunions after PLF versus PLIF were similar except for three-level fusions (2.9% [95% confidence interval, CI = 1.0-6.7] vs. 7.1% [95% CI = 0.2-33.9]). In adjusted models, there was no difference in risk of operative nonunions in PLIF compared to PLF (hazard ratio [HR]: 0.8, 95% CI = 0.4-1.6); however, patients with L5-S1 constructs with PLFs had 2.8 times the risk of operative nonunion compared to PLIFs (PLF: HR = 2.8, 95% CI = 1.3-6.2; PLIF: HR = 1.5, 95% CI = 0.4-5.1).

CONCLUSION

In a large cohort of patients with >4 years of follow-up, we found no difference in operative nonunions between PLF and PLIF except for constructs that included L5-S1 in which the risk of nonunion was limited to PLF patients.Level of Evidence: 3.

摘要

研究设计

一项通过病历回顾进行的回顾性队列研究。

目的

本研究旨在比较使用椎弓根螺钉的后外侧融合术（PLF）与使用椎弓根螺钉的后路椎间融合术（PLIF）治疗有症状骨不连的再次手术率（手术骨不连率）。

背景数据总结

尽管PLF和PLIF术中影像学骨不连在文献中有充分记载，但对于哪种技术骨不连发生率更低尚无共识。由于一些影像学骨不连可能无症状，一种更具临床实用性的指标是手术骨不连，而对此的研究极少。

方法

一项回顾性队列研究，使用凯撒医疗集团脊柱登记处的数据，纳入接受择期单节段和多节段PLF及PLIF的成年患者（≥18岁）。按融合节段（1 - 3节）、融合类型（PLF与PLIF）以及融合节段（L3至S1）计算手术骨不连的描述性统计数据和2年发生率。采用时间依赖性多变量Cox比例风险回归评估骨不连再次手术率，并对协变量进行校正。

结果

队列包括3065例接受PLF（71.6%）和PLIF（28.4%）的患者。平均年龄为65.0±11.7岁，平均随访时间为4.8±3.1年，手术骨不连的平均时间为1.6（±1.3）年。除三节段融合外，PLF与PLIF术后单节段和多节段骨不连发生率相似（2.9% [95%置信区间，CI = 1.0 - 6.7] 对比7.1% [95% CI = 0.2 - 33.9]）。在校正模型中，与PLF相比，PLIF手术骨不连风险无差异（风险比[HR]：0.8，95% CI = 0.4 - 1.6）；然而，L5 - S1节段行PLF的患者手术骨不连风险是行PLIF患者的2.8倍（PLF：HR = 2.8，95% CI = 1.3 - 6.2；PLIF：HR = 1.5，95% CI = 0.4 - 5.1）。