中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (12): 1936-1943.doi: 10.3969/j.issn.2095-4344.3793

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

腰椎后路融合术后邻近节段退变相关危险因素的Meta分析

张腾飞1，王  坤1，朱彦谕1，梅  伟2，王庆德2   

  1. 1河南中医药大学第二临床医学院，河南省郑州市   450002；2郑州市骨科医院脊柱外科，河南省郑州市   450052
  • 收稿日期:2020-04-13 修回日期:2020-04-17 接受日期:2020-05-22 出版日期:2021-04-28 发布日期:2020-12-26
  • 通讯作者: 梅伟，硕士，主任医师，郑州市骨科医院脊柱外科，河南省郑州市 450052
  • 作者简介:张腾飞，男，1995年生，河南省郑州市人，汉族，河南中医药大学在读硕士。
  • 基金资助:
    2018年郑州市科技惠民计划(河南省医学重点学科)(189PKJHM0780)，项目负责人：梅伟

Meta-analysis of risk factors associated with adjacent segment degeneration after lumbar posterior fusion

Zhang Tengfei1, Wang Kun1, Zhu Yanyu1, Mei Wei2, Wang Qingde2   

  1. 1Second School of Clinical Medicine, Henan University of Chinese Medicine, Zhengzhou 450002, Henan Province, China; 2Department of Spinal Surgery, Zhengzhou Orthopedics Hospital, Zhengzhou 450052, Henan Province, China
  • Received:2020-04-13 Revised:2020-04-17 Accepted:2020-05-22 Online:2021-04-28 Published:2020-12-26
  • Contact: Mei Wei, Master, Chief physician, Department of Spinal Surgery, Zhengzhou Orthopedics Hospital, Zhengzhou 450052, Henan Province, China
  • About author:Zhang Tengfei, Master candidate, Second School of Clinical Medicine, Henan University of Chinese Medicine, Zhengzhou 450002, Henan Province, China
  • Supported by:
    the Science and Technology Benefiting People Program of Zhengzhou (Key Medical Disciplines in Henan Province), No. 189PKJHM0780 (to MW)

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摘要：

文题释义：
腰椎后路融合：是腰椎手术中应用最广泛的一种经后侧入路的手术，通过对椎管的广泛减压和椎间或椎板间融合辅助内固定，从而扩大椎管容积并维持脊柱相对稳定，常用于治疗退变性腰椎不稳合并椎间盘突出、椎管狭窄或腰椎滑脱。手术方式包括后外侧椎间融合术、后路椎间融合术、经椎间孔椎间融合术等。
邻近节段退变：指脊柱融合术后融合节段的上方或下方出现椎间盘或椎间关节的退变，常发生于腰椎融合术后。

目的：随着腰椎椎弓根内固定系统的发展，腰椎后路融合术在治疗腰椎退行性疾病上应用逐渐广泛，邻近节段退变是腰椎融合术后的远期并发症之一，影响术后邻近节段退变的危险因素较多，部分因素尚存争议，因此有必要进行系统分析。为此文章探讨腰椎后路融合术后发生邻近节段退变的相关危险因素。
方法：计算机全面检索PubMed、The Cochrane Library、Embase、中国知网、万方和维普数据库，并手工检索中外影响因子较高的骨科类杂志，检索词主要包括“腰椎融合术”“邻近节段退变”“因素”“ASD”“risk factors”等，搜索年限为建库至2020年3月，包含腰椎后路融合术后发生邻近节段退变的单因素和(或)多因素分析。根据纳入及排除标准筛选文献后使用NOS量表严格评价文献质量。主要结局指标为年龄≥60岁，次要结局指标包括：性别(女)、吸烟史、体质量指数、骨质疏松、术前存在邻近节段退变、手术方式为后路椎间融合、融合节段>1、椎板切除和悬浮固定，其中体质量指数为连续型变量指标，其他均为二分类变量指标。提取相关数据后使用Revman 5.3软件进行统计分析。
结果：①共计18篇文献，其中14篇为高质量文献，中质量文献4篇，病例对照研究17篇，回顾性队列研究1篇，共纳入腰椎后路融合术后发生邻近节段退变患者568例，对照组2 936例；②年龄≥60岁(OR=2.59，95%CI：1.83-3.67，P < 0.000 01)、吸烟史(OR=1.63，95%CI：1.17-2.26，P=0.004)、体质量指数(OR=3.54，95%CI：2.67-4.41，P < 0.000 01)、术前存在邻近节段椎间盘退变(OR=3.68，95%CI：2.85-4.76，P < 0.000 01)、融合节段>1(OR=1.82，95%CI：1.39-2.38，P < 0.000 1)均与腰椎后路融合术后发生邻近节段退变显著相关；③年龄≥60岁(OR=2.62，95%CI：1.71-4.02，P < 0.000 01)、术前存在邻近节段椎间盘退变(OR=4.45，95%CI：3.08-6.44，P < 0.000 01)、融合节段>1(OR=1.56，95%CI：1.06-2.31，P=0.03)均是腰椎后路融合术后发生邻近节段退变的独立危险因素。
结论：性别、骨质疏松、手术方式、椎板切除和悬浮固定与腰椎后路融合术后发生邻近节段退变无明显相关性，但以上结论还需纳入大样本和高质量的临床研究加以验证。

https://orcid.org/0000-0002-4510-3949 (张腾飞) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨, 腰椎, 退变, 骨质疏松, 危险因素, 椎板, 固定, 并发症, Meta分析

Abstract: OBJECTIVE:  With the development of the lumbar pedicle internal fixation system, lumbar posterior fusion has been widely used in the treatment of degenerative diseases of the lumbar spine. Adjacent segment degeneration is one of the long-term complications after lumbar fusion. There are many risk factors affecting postoperative adjacent segment degeneration, some of which are still controversial, so it is necessary to conduct systematic analysis. Thus, this study investigated the risk factors of adjacent segment degeneration after posterior lumbar fusion.
METHODS: A comprehensive computer search was conducted for PubMed, The Cochrane Library, Embase, CNKI, Wanfang, and VIP database. The major orthopedic journals with high impact factors in and outside China were manually searched. The search term mainly included “lumbar fusion”, “adjacent segment degeneration”, “factors”, “ASD” and “risk factors”. The search period was from the database inception to March 2020, including the single-factor or multi-factor analysis of adjacent segment degeneration after lumbar posterior fusion. Literature quality was strictly evaluated using NOS scale after literature was screened according to inclusion and exclusion criteria. The primary outcome measure was age ≥ 60 years. Secondary outcome measures included: gender (female), smoking history, body mass index, osteoporosis, preoperative presence of adjacent segment degeneration, surgical approach of posterior lumbar interbody fusion, fusion segment > 1, laminectomy, and floating fusion. Among them, body mass index was a continuous variable index, and the rest were binary variables. Relevant data were extracted and statistically analyzed using Revman 5.3 software.
RESULTS: (1) A total of 18 literatures were included, among which 14 were of high quality, 4 were of medium quality, 17 were case control studies, and 1 was retrospective cohort study. A total of 568 patients with adjacent segment degeneration after lumbar posterior fusion were included, and 2 936 patients in the control group were included. (2) Age ≥ 60 years (OR=2.59, 95%CI:1.83-3.67), P < 0.000 01), smoking history (OR=1.63, 95%CI(1.17-2.26), P=0.004], body mass index (OR=3.54, 95%CI: 2.67-4.41), P < 0.000 01), preoperative presence of adjacent segment disc degeneration (OR=3.68, 95%CI: 2.85-4.76), P < 0.000 01), fusion segment > 1 (OR=1.82, 95%CI: 1.39-2.38), P < 0.000 1) were strongly correlated with adjacent segment degeneration after posterior lumbar fusion. (3) Age ≥ 60 years (OR=2.62, 95%CI:1.71-4.02, P < 0.000 01), preoperative presence of adjacent segment intervertebral disc degeneration (OR=4.45, 95%CI:3.08-6.44), P < 0.000 01), and fusion segment > 1 (OR=1.56, 95%CI:1.06-2.31), P=0.03] were independent risk factors for adjacent segment degeneration after lumbar posterior fusion.  
CONCLUSION: The gender, osteoporosis, operation method, laminectomy, and floating fusion had no obvious correlation with adjacent segment degeneration. However, the above conclusions need to be verified by large-sample and high-quality clinical studies.


Key words: bone, lumbar spine, degeneration, osteoporosis, risk factors, lamina, fixation, complications, meta-analysis

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