短节段腰椎融合术后患者的结局不受 PI-LL 不匹配的影响。

Patient Outcomes Following Short-segment Lumbar Fusion Are Not Affected by PI-LL Mismatch.

机构信息

Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.

出版信息

Clin Spine Surg. 2021 Mar 1;34(2):73-77. doi: 10.1097/BSD.0000000000001051.

DOI:10.1097/BSD.0000000000001051

PMID:33633060

Abstract

STUDY DESIGN

This is a retrospective cohort study.

OBJECTIVE

The objective of this study was to further elucidate the relationship between pelvic incidence-lumbar lordosis (PI-LL) mismatch and surgical outcomes in patients undergoing short segment lumbar fusions for degenerative lumbar disease.

SUMMARY OF BACKGROUND DATA

There are few studies examining the relationship between spinopelvic parameters and patient reported outcome measurements (PROMs) in short segment lumbar degenerative disease.

MATERIALS AND METHODS

A retrospective review was conducted at single academic institution. Patients undergoing 1- or 2-level lumbar fusion were retrospectively identified and separated into 2 groups based on postoperative PI-LL mismatch ≤10 degrees (NM) or PI-LL mismatch >10 degrees (M). Outcomes including the Physical Component Score (PCS)-12, Mental Component Score (MCS)-12, Oswestry Disability Index (ODI), Visual Analog Scale (VAS) back and leg scores were analyzed. Absolute PROM scores, the recovery ratio and the percentage of patients achieving minimum clinically important difference between groups were compared and a multiple linear regression analysis was performed.

RESULTS

A total of 306 patients were included, with 59 patients in the NM group and 247 patients in the M group. Patients in the M group started with a higher degree of PI-LL mismatch compared with the NM group (22.2 vs. 7.6 degrees, P<0.001) and this difference increased postoperatively (24.7 vs. 2.5 degrees, P<0.001). There were no differences between the 2 groups in terms of baseline, postoperative, or Δ outcome scores (P>0.05). In addition, having a PI-LL mismatch was not found to be an independent predictor of any PROM on multivariate analysis (P>0.05).

CONCLUSION

The findings in this study show that even though patients in the M group had a higher degree of mismatch preoperatively and postoperatively, there was no difference in PROMs.

LEVEL OF EVIDENCE

Level III.

摘要

研究设计

这是一项回顾性队列研究。

目的

本研究旨在进一步阐明骨盆入射角-腰椎前凸角（PI-LL）不匹配与退行性腰椎疾病行短节段腰椎融合术患者手术结果之间的关系。

背景资料概要

目前，研究脊柱骨盆参数与短节段退行性腰椎疾病患者报告的结果测量（PROMs）之间关系的研究较少。

材料与方法

在一家学术机构进行了回顾性研究。回顾性地确定了接受 1 或 2 个节段腰椎融合术的患者，并根据术后 PI-LL 不匹配≤10 度（NM）或 PI-LL 不匹配>10 度（M）将其分为 2 组。分析了包括物理成分评分（PCS-12）、精神成分评分（MCS-12）、Oswestry 残疾指数（ODI）、视觉模拟量表（VAS）腰背评分在内的结局指标。比较了两组之间的绝对 PROM 评分、恢复比值以及达到最小临床重要差异的患者比例，并进行了多元线性回归分析。

结果

共纳入 306 例患者，NM 组 59 例，M 组 247 例。与 NM 组相比，M 组患者的 PI-LL 不匹配起始程度更高（22.2°对 7.6°，P<0.001），且术后该差异进一步增大（24.7°对 2.5°，P<0.001）。两组患者的基线、术后或Δ结局评分之间无差异（P>0.05）。此外，多元分析未发现 PI-LL 不匹配是任何 PROM 的独立预测因子（P>0.05）。