腰椎融合术后邻近节段退化危险因素的Cox回归分析

摘要

Objective:To investigate the risk factors and the relative degree of postoperative occurrence of adjacent segment de-terioration (ASDet) after lumbar fusion. To reduce the occurrence of ASDet,improve the clinical efficacy of surgical treatment of lumbar fusion. Methods:136 cases who had been performed lumbar fusion were selected. All cases underwent MRI for eva-luating intervertebral disc degeneration. Cox proportional hazards regression model was used to analyze the correlation and the relative risk degree from the occurrence of ASDet and 9 related factors which included age,sex,osteoporosis,intervertebral disc degeneration,laminectomy,range of lumbar fusion,intervertebral disc space distraction,internal fixation,lumbosacral fusion. Result:Multivariate Cox regression analysis showed that intervertebral disc degeneration (RR=4.272,P=0.000) and intervertebral disc space distraction (RR=2.022,P=0.024) were significant correlated with the occurrence of ASDet. Conclusion:To choose operation reas-onably for the patients with intervertebral disc degeneration and not to distract the intervertebral disc space overmuch could re-duce the occurrence of ASDet.%目的：探讨腰椎融合术后邻近节段退化（adjacent segment deterioration,ASDet）的危险因素及相对风险度，以求降低患者术后发生ASDet的风险。方法：选择山东中医药大学附属医院2010年9月至2014年7月行腰椎融合手术患者136例。应用MRI评估患者术前椎间盘退变情况，应用Cox比例风险回归模型分析腰椎融合术后ASDet的发生与年龄、性别、骨质疏松、术前邻近节段椎间盘退变、椎板减压术、融合节段数、椎间隙撑开、使用内固定、腰骶椎融合等9个因素的相关性和风险性。结果：术前椎间盘退变（RR=4.272，P<0.01）和椎间隙撑开（RR=2.022，P=0.024）与术后ASDet的发生呈显著相关。结论：术前椎间盘退变及术中行椎间隙撑开可增加术后发生ASDet的风险。