Zhao Xuan, Wang Wei, Chen Xiaolong, Lu Shibao
Department of Orthopedics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China.
Laboratory for Clinical Medicine, Capital Medical University, Beijing, China.
J Orthop Surg Res. 2025 Jun 16;20(1):593. doi: 10.1186/s13018-025-06003-8.
Longitudinal changes in functional levels can provide valuable information regarding patient-reported outcome measures (PROMs). However, the longitudinal outcomes of lumbar fusion surgery in patients with metabolic syndrome (MetS) have not been well-documented, which could offer appropriate management strategies and insights for individuals with MetS. Therefore, the primary objective of this study was to investigate the 24-month longitudinal trajectory of PROMs in patients with MetS following lumbar fusion surgery.
This study retrospectively included patients who underwent lumbar fusion surgery for degenerative lumbar diseases from January 2021 to February 2023. The presence of MetS was determined according to the International Diabetes Federation (IDF) criteria. The Short Form-36 for physical component summary (SF-36 PCS) and mental component summary (SF-36 MCS) and the North American Spine Society (NASS) scale at baseline, 3, 6, 12, and 24 months after surgery were collected. The Wilcoxon signed-rank test and paired t-test were used to analyze differences in functional measurements across follow-up periods. Additionally, a generalized mixed-effects model was employed to analyze the longitudinal trajectories of PCS and MCS.
A total of 238 patients were included, with a mean age of 62.5 (4.2) years, and 143 (60.1%) were female. Among them, 74 (31.1%) patients had MetS, while 164 (68.9%) did not. In patients without MetS, NASS distribution improved gradually until 6-month follow-up, and then plateaued. In contrast, for patients with MetS, the NASS distribution reached a plateau at 12 months. Regarding PCS, patients without MetS showed gradual improvement from 3 months (47.5 ± 11.3) to 12 months postoperatively (67.9 ± 7.9), and then plateaued. In contrast, patients with MetS exhibited gradual improvement from 3 months (42.3 ± 8.9) to 24 months postoperatively (66.8 ± 11.4). Concerning MCS, regardless of MetS, patients' MCS improved gradually until 12 months postoperatively, and then plateaued. For patients without MetS, MCS scores were 49.1 (± 14.3) at 3 months and 65.3 (± 12.4) at 12 months postoperatively. For patients with MetS, MCS scores were 46.2 (± 13.7) at 3 months and 63.9 (± 13.5) at 12 months postoperatively.
This study evaluated the longitudinal trajectory of functional outcomes in patients with MetS undergoing lumbar fusion surgery, providing precise information on recovery patterns and emphasizing the importance of appropriate management and rehabilitation for both patients and physicians to achieve optimal outcomes.
功能水平的纵向变化可为患者报告结局指标（PROMs）提供有价值的信息。然而，代谢综合征（MetS）患者腰椎融合手术的纵向结局尚未得到充分记录，这可为MetS患者提供适当的管理策略和见解。因此，本研究的主要目的是调查腰椎融合手术后MetS患者24个月的PROMs纵向轨迹。
本研究回顾性纳入了2021年1月至2023年2月因退行性腰椎疾病接受腰椎融合手术的患者。根据国际糖尿病联盟（IDF）标准确定是否存在MetS。收集患者术前、术后3个月、6个月、12个月和24个月的简明健康状况调查量表身体成分总结（SF-36 PCS）、精神成分总结（SF-36 MCS）以及北美脊柱协会（NASS）量表。采用Wilcoxon符号秩检验和配对t检验分析随访期间功能测量的差异。此外，采用广义混合效应模型分析PCS和MCS的纵向轨迹。
共纳入238例患者，平均年龄62.5（4.2）岁，女性143例（60.1%）。其中，74例（31.1%）患者患有MetS，164例（68.9%）未患。在无MetS的患者中，NASS分布在6个月随访前逐渐改善，然后趋于平稳。相比之下，患有MetS的患者，NASS分布在12个月时达到平稳。关于PCS，无MetS的患者从术后3个月（47.5±11.3）到12个月逐渐改善（67.9±7.9），然后趋于平稳。相比之下，患有MetS的患者从术后3个月（42.3±8.9）到24个月逐渐改善（66.8±11.4）。关于MCS，无论是否患有MetS，患者的MCS在术后12个月前逐渐改善，然后趋于平稳。无MetS的患者术后3个月MCS评分为49.1（±14.3），12个月时为65.3（±12.4）。患有MetS的患者术后3个月MCS评分为46.2（±13.7），12个月时为63.9（±13.5）。
本研究评估了接受腰椎融合手术的MetS患者功能结局的纵向轨迹，提供了关于恢复模式的精确信息，并强调了适当管理和康复对患者和医生实现最佳结局的重要性。
