Xu Xiulei, Li Jun, Song Jie, Zhou Gang, Cai Jiren, Zhang Xiaorui
Department of Orthopedics, Xinjiang Production and Construction Corps First Division Alar Hospital, Alar City, Xinjiang, China.
Front Surg. 2025 May 26;12:1598799. doi: 10.3389/fsurg.2025.1598799. eCollection 2025.
BACKGROUND: Obese patients undergoing Unilateral Biportal Endoscopy (UBE) surgery for degenerative lumbar disc herniation may experience postoperative recovery significantly influenced by the degree of obesity and related factors. This study aims to evaluate the impact of obesity severity on postoperative complications and recovery progress following UBE surgery and to identify key intervention points. METHODS: Preoperative baseline characteristics and postoperative follow-up data of patients with mild, moderate, and severe obesity were collected to analyze the incidence of complications, postoperative recovery trajectories, and key influencing factors. Multivariate logistic regression was conducted to examine factors affecting early mobilization (within 24 h), length of hospital stay, and anesthesia recovery time. Generalized linear mixed models (GLMM) were utilized to assess longitudinal changes in postoperative pain, functional disability, walking capacity, and muscle strength over time and their interactions with body mass index (BMI). RESULTS: Obesity severity was significantly associated with the incidence of postoperative complications. Multivariate logistic regression analysis identified BMI classification, disc calcification, lumbar spondylolisthesis, and inflammatory markers as independent predictors of functional recovery, hospital stay, and anesthesia recovery time. Obese patients showed delayed functional recovery at the 3-month follow-up. Greater obesity severity was associated with slower improvements in walking ability at 1 and 3 months postoperatively. Moreover, obesity severity demonstrated a significant negative correlation with electromyographic activity at 1 month postoperatively. CONCLUSION: Obesity severity, inflammation, and anatomical factors are critical determinants of functional recovery in obese patients following UBE surgery. Patients with higher levels of obesity tend to have poorer mid- to long-term outcomes after UBE surgery. For such patients, enhanced postoperative mid- to long-term rehabilitation and physical function recovery are necessary to improve the prognosis of UBE.
背景：接受单侧双通道内镜（UBE）手术治疗退变性腰椎间盘突出症的肥胖患者，其术后恢复可能会受到肥胖程度及相关因素的显著影响。本研究旨在评估肥胖严重程度对UBE手术后并发症及恢复进程的影响，并确定关键干预点。 方法：收集轻度、中度和重度肥胖患者的术前基线特征和术后随访数据，以分析并发症发生率、术后恢复轨迹及关键影响因素。进行多因素逻辑回归分析，以检验影响早期活动（24小时内）、住院时间和麻醉恢复时间的因素。利用广义线性混合模型（GLMM）评估术后疼痛、功能障碍、步行能力和肌肉力量随时间的纵向变化及其与体重指数（BMI）的相互作用。 结果：肥胖严重程度与术后并发症发生率显著相关。多因素逻辑回归分析确定BMI分类、椎间盘钙化、腰椎滑脱和炎症标志物是功能恢复、住院时间和麻醉恢复时间的独立预测因素。肥胖患者在3个月随访时功能恢复延迟。肥胖严重程度越高，术后1个月和3个月时步行能力改善越慢。此外，肥胖严重程度与术后1个月时的肌电图活动呈显著负相关。 结论：肥胖严重程度、炎症和解剖因素是肥胖患者UBE手术后功能恢复的关键决定因素。肥胖程度较高的患者UBE手术后中长期预后往往较差。对于此类患者，加强术后中长期康复和身体功能恢复对于改善UBE手术预后是必要的。
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