目的 探讨腰大肌形态与经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)术后早期并发症的关系.方法 选取2018年1月至2022年12月首都医科大学宣武医院因腰椎管狭窄症行改良经TLIF患者,根据术后是否有并发症,分为未发生并发症组和并发症组.比较两组的一般资料、术中相关指标、腰大肌指数(psoas major index,PMI)和腰大肌CT值,采用多因素logistic回归方程分析PMI和腰大肌CT值对患者发生术后并发症的影响.结果 共纳入210患者,其中男75例、女135例,平均年龄(69.6±9.9)岁.27例患者(12.9%)出现了至少一种术后并发症,其中发生率最高的并发症为手术切口浅表感染(3.8%),其次是泌尿系感染或尿潴留(3.3%)和深部感染(1.9%).多因素logistic回归分析结果显示,PMI越低(OR=0.677,95%CI:0.478～0.958,P=0.028)和腰大肌CT值越低(OR=0.876,95%CI:0.791～0.970,P=0.011)的患者TLIF术后越容易出现早期并发症.结论 腰大肌PMI和CT值降低与TLIF术后早期并发症发生相关.术前评估腰大肌形态有助于识别TLIF术后发生并发症的高危人群.
Correlation analysis between psoas major muscle morphology and early complications after lumar interbody fusion in patients with lumbar spinal stenosis
Objective To explore the relationship between psoas major muscle morphology and the early complications after transforaminal lumbar interbody fusion(TLIF).Methods Patients who underwent modified TLIF for lumbar spinal stenosis in Xuanwu Hospital of Capital Medical University from January 2018 to December 2022 were selected and were divided into non-complication group and complication group according to whether they had complications or not after surgery.The general data,intraoperative related indicators,psoas major index(PMI)and psoas major CT value were compared between the two groups,and the effects of PMI and psoas major CT value on postoperative complications were analyzed by multivariate logistic regression equation.Results A total of 210 patients were selected,including 75 males and 135 females,with an average age of(69.6±9.9)years.Twenty-seven patients(12.9%)had at least one postoperative complication,among which superficial infection of surgical incision accounted for the highest incidence rate(3.8%),followed by urinary tract infection or urinary retention(3.3%)and deep infection(1.9%).Multivariate logistic regression analysis results showed that patients with lower PMI(OR=0.677,95%CI:0.478-0.958,P=0.028)and lower psoas major muscle CT value(OR=0.876,95%CI:0.791-0.970,P=0.011)were more likely to had early complications after TLIF.Conclusions The decrease of PMI and CT value of psoas major muscle are related to the occurrence of early complications after TLIF.Preoperative evaluation of psoas major muscle morphology is helpful to identify the high-risk group of complications after TLIF.
lumbar spinal stenosispsoas major index(PMI)perioperative complicationrisk factorsuperficial infection
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NSTL
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