Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, 100053, Beijing, China.
Xuanwu Hospital, China National Clinical Research Center for Geriatric Disorders, Capital Medical University, Beijing, China.
BMC Musculoskelet Disord. 2024 Aug 21;25(1):659. doi: 10.1186/s12891-024-07779-2.
Morphometric analysis of the psoas major muscle has shown utility in predicting postoperative morbidity in various surgical fields, but its usefulness in predicting complications in elderly patients undergoing multilevel lumbar fusion surgery has not been studied. The study aimed to investigate if psoas major parameters are independent risk factors of early postoperative complication among elderly patients.
Patients who underwent multilevel lumbar fusion for degenerative lumbar spinal stenosis (DLSS) were included. The psoas major was measured at the lumbar 3/4 intervertebral disc level in three ways on computed tomography image: psoas muscle mass index, mean muscle attenuation, and morphologic change of the psoas major. Early complications were graded using the Clavien-Dindo classification system and the Comprehensive complication index (CCI). A CCI ≥ 26.2 indicated severe complications. Logistic regression was performed to identify independent risk factors.
This retrospective study reviewed 108 patients (mean age 70.9 years, female to male ratio 1.8:1). Complications were observed in 72.2% of patients, with allogeneic blood transfusion being the most frequent (66.7%), followed by wound infection, acute heart failure (2.8% each). Severe complications occurred in 13.9% of patients. After multivariable regression analysis, those in the lowest psoas muscle attenuation tertile had higher odds of experiencing early postoperative complications (OR: 3.327, 95% CI 1.134-9.763, p = 0.029) and severe complications (OR: 6.964, 95% CI 1.928-25.160, p = 0.003).
The psoas muscle attenuation can be used as a predictor of early postoperative complications in elderly patients undergoing multilevel lumbar fusion surgery for DLSS.
腰大肌的形态计量分析已在多个外科领域显示出预测术后发病率的作用，但它在预测行多节段腰椎融合术的老年患者并发症方面的作用尚未得到研究。本研究旨在探讨腰大肌参数是否为老年退行性腰椎管狭窄症（DLSS）患者行多节段腰椎融合术后早期并发症的独立危险因素。
纳入接受多节段腰椎融合术治疗退行性腰椎管狭窄症的患者。在 CT 图像上，从三个方面测量第 3/4 腰椎间盘水平的腰大肌：腰大肌质量指数、平均肌肉衰减值和腰大肌形态变化。采用 Clavien-Dindo 分级系统和综合并发症指数（CCI）对早期并发症进行分级。CCI≥26.2 表示严重并发症。采用 logistic 回归分析识别独立危险因素。
这项回顾性研究共纳入 108 例患者（平均年龄 70.9 岁，男女比例为 1.8:1）。72.2%的患者发生了并发症，最常见的是异体输血（66.7%），其次是伤口感染和急性心力衰竭（各占 2.8%）。13.9%的患者发生了严重并发症。多变量回归分析后，腰大肌衰减值最低三分位的患者发生术后早期并发症的可能性更高（OR：3.327，95%CI 1.134-9.763，p=0.029）和严重并发症（OR：6.964，95%CI 1.928-25.160，p=0.003）。
腰大肌衰减值可用于预测老年退行性腰椎管狭窄症患者行多节段腰椎融合术后早期并发症。
