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投稿时间：2025-03-12 网络发布日期：2025-12-25
投稿时间：2025-03-12 网络发布日期：2025-12-25
中文摘要: 目的 分析退变性脊柱侧凸（DS）患者脊柱矫形手术后腰骶部器械内固定失败（LSMF）发生的相关危险 因素，并探究腰椎椎间融合（LIF）是否有助于减少DS患者LSMF的发生率。方法 回顾性分析2010年1月至 2022年7月于南京大学医学院附属鼓楼医院进行后路脊柱矫形并行腰骶部内固定融合手术的DS患者的临床和 影像学数据。根据是否发生LSMF分为LSMF组（n=16）和非LSMF组（n=80）。根据是否接受LIF分为LIF组（n= 64）和非LIF组（n=32）。对比接受LIF组和非LIF组LSMF的发生率，并比较两组患者临床及影像学数据。采 用多因素logistic回归分析影响LSMF发生的相关因素。结果 共96例患者纳入本研究，其中64例（66.7%）患 者接受LIF。观察到16例（16.7%）LSMF，包括LIF组9例（14.1%）和非LIF组7例（21.9%），两组间LSMF发生率 差异无统计学意义（χ2=0.938，P=0.333）。LIF组比非LIF组患者显著更多地使用卫星棒（95.3% vs 75.0%，χ2= 6.789，P=0.009），包括在L4 ~S1 区域卫星棒的使用率也明显高于非LIF组（89.1% vs 68.8%，χ2=6.040，P=0.014）。 LSMF组的三柱截骨率（68.8% vs 37.5%，χ2=5.322，P=0.021）显著高于无LSMF组。术前影像学参数中，与非 LSMF组相比，LSMF组骨盆倾斜角（37.50°±8.33° vs 29.50°±7.94°，t=3.650，P0.05）。结论 在L4 ~S1 区域使用卫星棒可能有助 于降低DS患者LSMF风险，而三柱截骨术可能升高LSMF发生率。LIF不能显著降低DS患者LSMF的发生率。
Abstract:Objective To analyze the risk factors associated with the occurrence of lumbosacral instrumentation failure (LSMF) after spinal correction surgery in patients with degenerative scoliosis (DS), and to investigate whether lumbar interbody fusion (LIF) helps reduce the incidence of LSMF in DS patients. Methods A retrospective analysis was conducted on the clinical and imaging data of DS patients who underwent posterior spinal correction surgery with lumbosacral instrumentation fusion from January 2010 to July 2022 at the Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School. The patients were divided into an LSMF group (n=16) and a non-LSMF group (n=80) according to the occurrence of LSMF, and into an LIF group (n=64) and a non-LIF group (n=32) based on whether LIF was performed. The incidence of LSMF between LIF group and non-LIF group was compared, along with clinical and imaging data. Multivariate logistic regression analysis was used to identify factors associated with LSMF occurrence. Results A total of 96 patients were included in this study, of whom 64 (66.7%) underwent LIF. LSMF was observed in 16 patients (16.7%), including 9 cases (14.1%) in the LIF group and 7 cases (21.9%) in the non-LIF group. There was no significant difference in LSMF incidence between LIF group and non-LIF group (χ2=0.938, P= 0.333). The LIF group showed a significantly higher utilization of satellite rods compared to the non-LIF group (95.3% vs 75.0%, χ2=6.789, P=0.009), including a higher rate of satellite rod use in the L4-S1 region (89.1% vs 68.8%, χ2= 6.040, P=0.014). The rate of three-column osteotomy was significantly higher in the LSMF group than that in the non-LSMF group (68.8% vs 37.5%, χ2=5.322, P=0.021). Among preoperative imaging parameters, pelvic tilt (37.50°± 8.33° vs 29.50°±7.94°, t=3.650, P<0.01) and T1 pelvic angle (40.42°±9.66° vs 32.33°±9.11°, t=3.213, P=0.002) were significantly higher in the LSMF group compared to the non-LSMF group, while sacral slope and lumbar lordosis were significantly lower (P<0.05). Multivariate logistic regression analysis revealed that none of the aforementioned parameters were significant risk factors for predicting LSMF occurrence (P>0.05). Conclusion The use of satellite rods in the L4-S1 region may help mitigate the risk of LSMF in DS patients, while three-column osteotomy may increase the incidence of LSMF. LIF does not significantly reduce the incidence of LSMF in DS patients.
keywords: Degenerative scoliosis Mechanical failure Lumbar interbody fusion Risk factors Pelvic tilt angle Satellite rod Triple-column osteotomy
文章编号： 中图分类号：R682.1+3 文献标志码：A
基金项目:国家自然科学基金区域创新发展联合基金重点支持项目（U24A20671）
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引用文本：
马鸿儒,戴瑜彤,刘万友,等.腰椎椎体间融合对退变性脊柱侧凸患者矫形术后腰骶部内固定失败的影响[J].中国临床研究,2025,38(12):1882-1886，1892.
马鸿儒,戴瑜彤,刘万友,等.腰椎椎体间融合对退变性脊柱侧凸患者矫形术后腰骶部内固定失败的影响[J].中国临床研究,2025,38(12):1882-1886，1892.