Lai Juyi, Li Xinbei, Tan Huangsheng, Feng Hualong, Lan Zhi Ming, Sun Zhitao, Wang Jian, Fu Yuanfei, He Shenghua
Orthopedics department, Shenzhen Traditional Chinese Medicine Hospital (The fourth Clinical Medical College of Guangzhou University of Chinese Medicine), No.1, Fuhua Road, Futian District, Shenzhen, Guangdong Province, China.
Radiography department, Shenzhen Traditional Chinese Medicine Hospital (The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine), No.1, Fuhua Road, Futian District, Guangdong, Shenzhen, China.
BMC Surg. 2025 Aug 14;25(1):372. doi: 10.1186/s12893-025-03075-5.
This study aimed to investigate the impact of sarcopenia on the clinical outcomes of patients undergoing posterior surgical treatment for degenerative lumbar scoliosis.
A retrospective analysis was conducted on clinical data from 76 patients with degenerative lumbar scoliosis, who meet the selection criteria between January 2019 and December 2023. The patients were categorized into a sarcopenia group (31 cases) and a non-sarcopenia group (45 cases) based on the diagnostic criteria of the European Working Group on Sarcopenia in Older People (EWGSOP). Operative time, intraoperative blood loss, hospital stay duration, incision length, incision healing time, and complications were compared between the sarcopenia and non-sarcopenia groups. The improvement in clinical symptoms was evaluated using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). To assess the scoliosis correction effect, measurements were taken for the coronal Cobb angle (CCA), C7 plumb line-center sacral vertical line (C7-CSVL), lumbar lordosis (LL), and C7 plumb line-sagittal vertical axis (C7-SVA).
All patients successfully underwent the surgical procedure. The average operation time in the sarcopenia group was 256.27 ± 28.09 (180-350) min, which was not significantly different from the 249.82 ± 24.35(185-320) min in the non-sarcopenia group (p > 0.05). The average intraoperative blood loss in the sarcopenia group was 786.25 ± 38.19 (420-1365) mL, compared to 810.62 ± 45.47 (456-1780) mL in the non-sarcopenia group (p > 0.05). The average incision length in the sarcopenia group was 12.57 ± 1.29 (10-16)cm, compared to 12.83 ± 2.03 (9-20)cm in the non-sarcopenia group (p > 0.05). The incision healing time in the sarcopenia group required an average of 15.72 ± 1.74 (12-25)d, which longer than the 10.18 ± 1.05 (10-14 ) d in the non-sarcopenia group (p < 0.05). The average hospital stay in the sarcopenia group was 13.46 ± 1.37 (8-26) d, which was also longer than the 8.33 ± 0.92 (6-12)d in the non-sarcopenia group (p < 0.05). The complication rate in the sarcopenia group was 29.03% (9/31), which was higher than the 13.33% (6/45) in the non-sarcopenia group (p < 0.05). The VAS and ODI scores of both groups at the last follow-up were significantly improved compared to preoperative levels (p < 0.05). At the last follow-up, the ODI in the non-sarcopenia group was better than that in the sarcopenia group (p < 0.05). There was no statistically significant difference between the two groups in terms of VAS scores at the last follow-up (p > 0.05). Both groups demonstrated significant improvements in CCA, C7-CSVL, LL, and C7-SVA compared to preoperative levels (p < 0.05). However, no statistically significant differences were observed between the groups at the final follow-up (p > 0.05).
Sarcopenia does not significantly affect the radiological outcomes of patients with degenerative lumbar scoliosis undergoing posterior surgical procedures, ODI was better in the non-sarcopenia group. In addition, patients with sarcopenia typically require a longer postoperative recovery period and are more susceptible to various complications compared to those without sarcopenia.
本研究旨在探讨肌肉减少症对退行性腰椎侧弯后路手术患者临床结局的影响。
对2019年1月至2023年12月期间符合入选标准的76例退行性腰椎侧弯患者的临床资料进行回顾性分析。根据老年人肌肉减少症欧洲工作组（EWGSOP）的诊断标准，将患者分为肌肉减少症组（31例）和非肌肉减少症组（45例）。比较肌肉减少症组和非肌肉减少症组的手术时间、术中出血量、住院时间、切口长度、切口愈合时间及并发症情况。采用视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）评估临床症状改善情况。为评估脊柱侧弯矫正效果，测量冠状面Cobb角（CCA）、C7铅垂线-骶骨中心垂直线（C7-CSVL）、腰椎前凸（LL）及C7铅垂线-矢状垂直轴（C7-SVA）。
所有患者均成功接受手术。肌肉减少症组平均手术时间为256.27±28.09（180 - 350）分钟，与非肌肉减少症组的249.82±24.35（185 - 320）分钟相比，差异无统计学意义（p＞0.05）。肌肉减少症组平均术中出血量为786.25±38.19（420 - 1365）毫升，非肌肉减少症组为810.62±45.47（456 - 1780）毫升（p＞0.05）。肌肉减少症组平均切口长度为12.57±1.29（10 - 16）厘米，非肌肉减少症组为12.83±2.03（9 - 20）厘米（p＞0.05）。肌肉减少症组切口愈合时间平均需要15.72±1.74（12 - 25）天，长于非肌肉减少症组的10.18±1.05（10 - 14）天（p＜0.05）。肌肉减少症组平均住院时间为13.46±1.37（8 - 26）天，也长于非肌肉减少症组的8.33±0.92（6 - 12）天（p＜0.05）。肌肉减少症组并发症发生率为29.03%（9/31），高于非肌肉减少症组的13.33%（6/45）（p＜0.05）。两组末次随访时的VAS和ODI评分均较术前显著改善（p＜0.05）。末次随访时，非肌肉减少症组的ODI优于肌肉减少症组（p＜0.05）。两组末次随访时VAS评分差异无统计学意义（p＞0.05）。与术前相比，两组的CCA、C7-CSVL、LL及C7-SVA均有显著改善（p＜0.05）。然而，末次随访时两组间差异无统计学意义（p＞0.05）。
肌肉减少症对退行性腰椎侧弯后路手术患者的影像学结局无显著影响，非肌肉减少症组的ODI更佳。此外，与无肌肉减少症的患者相比，肌肉减少症患者术后恢复时间通常更长，更容易发生各种并发症。
