斜外侧入路腰椎融合术术后终板塌陷危险因素分析

Risk Factors for Endplate Collapse after Oblique Lateral Interbody Fusion

摘要: 背景与目的：斜外侧入路腰椎融合术(OLIF)通过置入大型椎间融合器达到恢复椎间高度与间接减压的目的，大型椎间融合器带来的支撑力也使得OLIF技术可以不必联合后方椎弓根螺钉的固定，由此产生了Stand-Alone技术与侧方钢板固定技术。然而此类技术并不能为所有患者提供足够的支撑稳定性，存在着较高的终板塌陷率，进而导致融合失败。本研究通过分析接受斜外侧入路腰椎融合术的患者的临床资料及术中决策差异，探讨OLIF术后发生终板塌陷的危险因素。旨在指导临床进行更精准、安全、有效的术式选择。方法：选取2021年2月至2022年2月期间在我院接受OLIF及OLIF联合侧方钢板固定的患者64例，共80个手术节段。根据术后6个月CT终板有无塌陷分为塌陷组与非塌陷组。比较两组患者的一般资料(性别、年龄、BMI)；影像资料(是否合并滑脱、椎体的动态稳定性、责任节段上下椎体的CT均值、融合节段数)；手术决策以及术中操作所带来的差异(椎间隙高度变化、是否联合侧方钢板固定、是否合并术中终板损伤)。将单因素分析中P < 0.05的潜在危险因素，纳入Logistic回归开展多因素分析并绘制列线图。结果：80个手术节段中，发生终板塌陷24例(30%)。危险因素分析显示：椎体动态不稳、椎体低CT值与术中终板损伤为术后终板塌陷的独立危险因素。患者的性别、年龄、BMI、融合节段数、椎体撑开高度及是否联合侧方钢板固定与是否发生终板塌陷无统计学关联。结论：椎体动态不稳、椎体低CT值与术中终板损伤为术后终板塌陷的独立危险因素。联合侧方钢板固定对于术后终板塌陷并无显著保护作用。对于此类患者应采取更强的内固定方式。

Abstract: Background and purpose: Oblique lateral interbody fusion (OLIF) restores intervertebral height and indirect decompression by placing a large intervertebral cage, and the support provided by the large intervertebral cage allows the OLIF technique to be performed without posterior pedicle screw fixation, resulting in the Stand-Alone technique and lateral plate fixation. However, these techniques cannot provide adequate support stability for all patients and have a high rate of end-plate collapse, which can lead to fusion failure. This study investigated the risk factors for endplate collapse after OLIF by analyzing the clinical data and intraoperative decision-making differences among patients undergoing lumbar fusion with an oblique lateral approach. The aim was to guide the clinical selection of a more precise, safe, and effective surgical procedure. Methods: Sixty-four patients who underwent OLIF and OLIF combined with lateral plate fixation in our hospital between February 2021 and February 2022 were selected, with a total of 80 surgical segments. They were divided into collapsed and non-collapsed groups according to the presence or absence of collapsed CT endplates at 6 months postoperatively. The general data (gender, age, BMI); imaging data (whether combined with slippage, dynamic stability of the vertebral body, mean CT values of the vertebral body above and below the responsible segment, and the number of fused segments); sur-gical decision and differences brought about by intraoperative operations (change in vertebral space height, whether combined with lateral plate fixation, and whether combined with intraopera-tive endplate injury) were compared between the two groups. Potential risk factors with P < 0.05 in the univariate analysis were included in the logistic regression for multivariate analysis and plotted on a line graph. Results: Out of 80 operated segments, endplate collapse occurred in 24 cases (30%). Risk factor analysis showed that dynamic instability of the vertebral body, low CT values of the ver-tebral body, and intraoperative endplate injury were independent risk factors for postoperative endplate collapse. There was no statistically significant association between patient gender, age, BMI, number of fused segments, vertebral body spreading height, and combined lateral plate fixa-tion and the occurrence of endplate collapse. Conclusion: Dynamic instability of the vertebral body, low CT values of the vertebral body, and intraoperative endplate injury were independent risk fac-tors for postoperative endplate collapse. Combined lateral plate fixation did not provide significant protection against postoperative endplate collapse. Stronger internal fixation should be used in such patients.