Andreshak T G, An H S, Hall J, Stein B
Consulting Orthopaedic Associates, Inc., St. Vincent Medical Center, Toledo, Ohio, USA.
J Spinal Disord. 1997 Oct;10(5):376-9.
A prospective study was performed in obese and nonobese patients undergoing lumbar spine surgery to report perioperative data and surgical outcomes. One hundred fifty-nine consecutive patients who underwent lumbar spine surgery by a single surgeon entered the study. Among 159 consecutive patients, 55 met the criteria for obesity (> 20% ideal body weight). The average weight was 226 lb in the obese group. There were 28 men and 27 women with ages ranging from 25 to 81 years, with a mean of 47.9 years. The diagnoses and procedures included 31% herniated nucleus pulposus with laminotomy and discectomy, 14% spinal stenosis with laminectomy, and 55% lumbar fusion procedures for other disorders. Twenty-nine percent had previous lumbar surgery that had failed. Results indicated that there were no significant differences between the obese and control groups in terms of duration of surgery (3.8 versus 3.2 h), blood loss (723 versus 605 ml), and duration of hospital stay (5.6 versus 5.8 days). The clinical results were 24% excellent, 40% good, 27% fair, and 9% poor in the obese group; and 27% excellent, 37% good, 19% fair, and 17% poor in the control group. This study found no significant differences between obese and control patients relative to blood loss, operative time, hospital stay, rate of complications, and functional outcome in lumbar spine surgery. Patient selection continues to be the most important factor in terms of operative success. We believe that lumbar spine surgery, including fusion, should not be withheld from obese patients who present with proper indications for surgery and fail an appropriate course of conservative treatment.
对接受腰椎手术的肥胖和非肥胖患者进行了一项前瞻性研究，以报告围手术期数据和手术结果。159例连续接受同一位外科医生进行腰椎手术的患者进入该研究。在这159例连续患者中，55例符合肥胖标准（超过理想体重的20%）。肥胖组的平均体重为226磅。其中有28名男性和27名女性，年龄在25至81岁之间，平均年龄为47.9岁。诊断和手术包括31%的腰椎间盘突出症行椎板切开术和椎间盘切除术，14%的腰椎管狭窄症行椎板切除术，以及55%的其他疾病行腰椎融合术。29%的患者既往腰椎手术失败。结果表明，肥胖组和对照组在手术时间（3.8小时对3.2小时）、失血量（723毫升对605毫升）和住院时间（5.6天对5.8天）方面无显著差异。肥胖组的临床结果为24%优、40%良、27%中、9%差；对照组为27%优、37%良、19%中、17%差。本研究发现，在腰椎手术中，肥胖患者和对照患者在失血量、手术时间、住院时间、并发症发生率和功能结局方面无显著差异。就手术成功而言，患者选择仍然是最重要的因素。我们认为，对于有适当手术指征且保守治疗适当疗程失败的肥胖患者，不应拒绝进行包括融合术在内的腰椎手术。
