摘要
目的探讨腰椎椎体松质骨和终板Hounsfield Units(HU)对腰椎后路椎板切除减压、椎间融合术后融合器沉降的预测价值,为手术方案的制定和风险告知提供指导。方法回顾性分析2013年1月至2018年12月接受腰椎后路椎板切除减压、椎间融合术的腰椎间盘突出症患者72例,男21例,女51例;年龄(62.7±3.9)岁(范围37~69岁)。融合器沉降定义为随访时腰椎CT矢状位融合器突破终板>4 mm,依据术后1年时椎间融合器的沉降与否进行分组,18例患者纳入沉降组,54例患者纳入无沉降组。对比两组患者腰椎前凸角、节段性前凸角、椎间盘高度、术后下地时间、住院时间及围手术期并发症情况,比较上、下固定椎的松质骨和终板HU值,采用ROC曲线分析融合器沉降时的椎体松质骨和终板临界HU值。结果沉降组18例患者中14例融合器突破进入L4下终板,4例融合器突破进入L5上终板。两组患者术前腰椎前凸角、节段性前凸角、椎间隙高度、术后下地时间、住院时间及并发症的差异均无统计学意义。松质骨和终板HU值测量的ICC值为0.872。沉降组L4椎体松质骨HU值为125.9±18.6、L5椎体松质骨HU值为158.7±17.7,均低于无沉降组(L4:155.6±26.5;L5:182.4±29.7)。沉降组L4下终板HU值为278.7±24.2、L5上终板HU值为235.9±30.8,均低于无沉降组(L4:331.6±55.9;L5:273.8±55.7)。ROC曲线显示融合器沉降的L4松质骨、L5松质骨、L4下终板、L5上终板临界HU值分别为146、172、307和254。结论椎体松质骨和终板HU值对于腰椎后路椎板切除减压、椎间融合术后融合器沉降具有潜在的预测价值。对于低于临界HU值的患者,术前应交待发生融合器沉降的风险,术中尽可能选择较大的融合器十分必要。
Objective To explore the predictive value of vertebral trabecular and endplate HU values on cage subsidence after posterior lumbar interbody fusion(PLIF),hope to provide reference for surgical planning.Methods All of 72 patients with lumbar disc herniation that underwent PLIF were retrospectively reviewed,who were divided into two groups according to the occurrence of cage subsidence at one-year follow up.Cage subsidence was defined as more than 4 mm subsidence into the vertebrae valuated by CT at one-year follow up.There were 18 patients enrolled into Subsidence group and 54 patients enrolled into N-Subsidence group.The lumbar lordosis,segmental lordosis,intervertebral height,off-bed time,hospital stay,complications,the trabecular and endplate HU values of upper instrumented vertebrae(UIV)and lower instrumented vertebrae(LIV)were compared between the two groups.ROC was used to explore the thresholds of HU values.Results There were 14 patients presented cage subsidence into the L4,4 patients presented cage subsidence into the L5.There was no significant difference in lumbar lordosis,segmental lordosis,intervertebral height,off-bed time,hospital stay,or complications between the two groups.Both UIV and LIV trabecular and endplate showed a lower HU value in Subsidence group than those in N-Subsidence group.The most appropriate thresholds of HU value were 146,172,307,254 for trabecular of UIV,trabecular of LIV,lower endplate of UIV,and upper endplate of LIV,respectively.Conclusion Vertebral trabecular and endplate HU values could effectively predict the cage subsidence after PLIF,patients should be completely informed the risk of cage subsidence and larger cage should be recommended if they presented HU values under the certain threshold.
作者
王辉
邹达
孙卓然
王龙杰
姜帅
李危石
Wang Hui;Zou Da;Sun Zhuoran;Wang Longjie;Jiang Shuai;Li Weishi(Department of Orthopaedics,Peking University Third Hospital,Beijing 100191,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2021年第13期864-871,共8页
Chinese Journal of Orthopaedics
关键词
腰椎
脊柱融合术
手术后并发症
体层摄影术
螺旋计算机
Lumbar vertebrae
Spinal fusion
Postoperative complications
Tomography,spiral computed
