两种植骨融合内固定术治疗骨质疏松老年腰椎管狭窄症的效果

doi:10.20047/j.issn1673-7210.2023.15.18

摘要
图/表
参考文献(27)
相关文章 (15)

全文: PDF (689 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的观察使用单纯植骨与使用融合器的PLIF手术治疗骨质疏松老年退行性腰椎管狭窄症的效果。方法将2019年8月至2021年12月河北工程大学附属医院治疗的75例骨质疏松老年退行性腰椎管狭窄症患者作为研究对象，采用随机数字表法，分为单纯植骨治疗组（38例）和椎间融合器治疗组（37例）。应用视觉模拟（VAS）评分和Oswestry功能障碍指数（ODI）评分量表分别于术前、术后6个月对两组评分并比较；比较术前、术后1个月及术后18个月减压节段椎间隙高度；两组住院天数、住院费用及术中减压节段椎间隙植骨量；两组术后3、18个月植骨融合情况。结果术后，两组ODI、VAS评分低于术前，差异有统计学意义（P＜0.05）。两组术后ODI、VAS评分比较，差异无统计学意义（P＞0.05）。整体分析发现，两组组间、交互作用比较，差异无统计学意义（P＞0.05）；不同时间比较，差异有统计学意义（P＜0.05）。进一步两两比较，术后1个月两组减压节段椎间隙高度高于术前，术后18个月两组减压节段椎间隙高度低于术后1个月，差异有统计学意义（P＜0.05）。两组住院天数比较，差异无统计学意义（P＞0.05）。椎间融合器治疗组住院费用高于单纯植骨治疗组，减压节段椎间隙植骨量低于单纯植骨治疗组，差异有统计学意义（P＜0.05）。术后3个月单纯植骨治疗组植骨融合例数多于椎间融合器治疗组，差异有统计学意义（P＜0.05）。术后18个月两组植骨融合例数比较，差异无统计学意义（P＞0.05）。结论经保守治疗无效的骨质疏松老年退行性腰椎管狭窄症患者，选择经腰椎后路椎管减压、单纯植骨融合、椎弓根螺钉内固定术可以达到经济有效的治疗目的。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	贺靖澜1　　林晓光1　　汪亮1　　赵艳春1　　张瑞英2　　申娜3

关键词 ：腰椎管狭窄, 单纯植骨, 内固定, 老年

Abstract：Objective To observe the effect of PLIF surgery with bone graft alone and fusion apparatus in the treatment of osteopolitic senile degenerative lumbar spinal stenosis. Methods A total of 75 elderly patients with osteoporosis and degenerative lumbar spinal stenosis treated in the Affiliated Hospital of Hebei University of Technology from August 2019 to December 2021 were selected as subjects. By random number table method, they were divided into bone graft treatment group (38 cases) and interbody fusion cage treatment group (37 cases). Visual analog scale (VAS) and Oswestry disability index (ODI) scale were used to score and compare the two groups before and six months after surgery. The height of decompression intervertebral space before surgery, 1 month after surgery and 18 months after surgery, the length of hospitalization, hospitalization cost, and the amount of bone graft in the intervertebral space during decompression between the two groups, and the situation of bone graft fusion between the two groups 3 and 18 months after surgery were compared. Results After operation, ODI and VAS scores of the two groups were lower than those before operation, and the differences were statistically significant (P＜0.05). There were no significant differences in postoperative ODI and VAS scores between the two groups (P＞0.05). The overall analysis showed that there was no significant difference in the interaction between the two groups (P＞0.05). The difference was statistically significant at different time points (P＜0.05). Further pair-wise comparison showed that the decompression level vertebral space height of the two groups was higher than that before surgery a month after surgery, and the decompression level vertebral space height of the two groups was lower than that 1 month after surgery and 18 months after surgery, with statistical significance (P＜0.05). There was no significant difference in the length of hospitalization between the two groups (P＞0.05). The hospitalization cost of the interbody fusion apparatus treatment group was higher than that of the single bone graft treatment group, the amount of bone graft in the decompression intervertebral space was lower than that of the single bone graft treatment group, and the differences were statistically significant (P＜0.05). Three months after surgery, the number of bone graft fusion cases in the simple bone graft treatment group was larger than that in the interbody fusion device treatment group, and the difference was statistically significant (P＜0.05). There was no significant difference in the number of bone graft fusion cases between the two groups 18 months after surgery (P＞0.05). Conclusion For elderly patients with osteoporotic degenerative lumbar spinal stenosis who have failed conservative treatment, posterior lumbar spinal decompression, simple bone graft fusion, and pedicle screw internal fixation can achieve economical and effective treatment.

Key words： Lumbar spinal stenosis Bone graft alone Internal fixation Elderly

基金资助:河北省科技厅重点研发项目基金资助项目（21377797D）。

通讯作者: 申娜（1982.2-），女，博士，副主任医师；研究方向：老年性退行性疾病。

作者简介: 贺靖澜（1980.9-），男，硕士，副主任医师；研究方向：创伤骨折、脊柱骨病。

引用本文:

贺靖澜1　　林晓光1　　汪亮1　　赵艳春1　　张瑞英2　　申娜3. 两种植骨融合内固定术治疗骨质疏松老年腰椎管狭窄症的效果[J]. 中国医药导报, 2023, 20(15): 86-89,94.
HE Jinglan1 LIN Xiaoguang1 WANG Liang1 ZHAO Yanchun1 ZHANG Ruiying2 SHEN Na3. Effect of two bone implants fusion and internal fixation in the treatment of osteoporotic elderly lumbar spinal stenosis. 中国医药导报, 2023, 20(15): 86-89,94.

链接本文:

https://www.yiyaodaobao.com.cn/CN/10.20047/j.issn1673-7210.2023.15.18 或 https://www.yiyaodaobao.com.cn/CN/Y2023/V20/I15/86

[1] 尹鹏，海涌，杨晋才，等，经皮内镜下经椎间孔与传统后入路椎间融合术治疗伴有腰椎不稳的腰椎管狭窄症的疗效对比[J].中国脊柱脊髓杂志，2021，31（3）：213-221.
[2] Ravindra V，Senglaub S，Rattani A，et al. Degenerative Lumbar Spine Disease：Estimating Global Incidence and Worldwide Volume [J]. Global Spine Journal，2018，8（8）：784-794.
[3] Katz J，Zimmerman Z，Mass H，et al. Diagnosis and Management of Lumbar Spinal Stenosis：A Review [J]. JAMA，2022， 327（17）：1688-1699.
[4] Ghogawala Z，Dziura J，Butler W，et al. Laminectomy plus Fusion versus Laminectomy Alone for Lumbar Spondylolisthesis [J]. N Engl J Med，2016，374（15）：1424-1434.
[5] Hermansen E，Austevoll IM，Hellum C，et al. Comparison of 3 Different Minimally Invasive Surgical Techniques for Lumbar Spinal Stenosis：A Randomized Clinical Trial [J]. JAMA，2022，5（3）：e224291.
[6] Schneider M，Ammendolia C，Murphy D，et al. Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis：A Randomized Clinical Trial [J]. JAMA，2019，2（1）：e186828.
[7] 沙春河，许卫兵.退行性腰椎管狭窄症的治疗进展[J].世界最新医学信息文摘，2019，19（50）：128-129，131.
[8] Zhang J，Liu T，Shan H，et al. Decompression Using Minimally Invasive Surgery for Lumbar Spinal Stenosis Associated with Degenerative Spondylolisthesis：A Review [J]. Pain，2021，10（2）：941-959.
[9] Hermansen E，Austevoll I，Hellum C，et al. Comparison of 3 Different Minimally Invasive Surgical Techniques for Lumbar Spinal Stenosis：A Randomized Clinical Trial [J]. JAMA， 2022，5（3）：e224291.
[10] 邓必权，胡华，滕宇，等.椎弓根螺钉复位内固定后单纯植骨融合与椎间融合器融合治疗腰椎滑脱症的疗效比较[J].中国老年学杂志，2015（7）：1823-1825.
[11] 李政，胡洪波，李玉民，等.单纯PLIF与PLIF联合椎间融合器治疗腰椎滑脱的疗效比较[J].中国骨与关节损伤杂志，2017，32（5）：505-507.
[12] 谢鹏，李学东，杜世新.探讨PLIF治疗腰椎管狭窄症的临床疗效[J].中国伤残医学，2021，29（9）：1-2.
[13] Choi WS，Oh CH，Ji GY，et al. Spinal canal morphology and clinical outcomes of microsurgical bilateral decompression via a unilateral approach for lumbar spinal canal stenosis [J]. Eur Spine J，2014，23（5）：991-998.
[14] Froud R，Patel S，Rajendran D，et al. A systematic review of outcome measures use，ana- lytical approaches，reporting methods，and publication volume by year in low back pain trials published between 1980 and 2012：respice，adspice，et prospice [J]. PLoS One，2016，11（10）：e0164573
[15] Chiarotto A，Maxwell L，Ostelo R，et al. Measurement Properties of Visual Analogue Scale，Numeric Rating Scale，and Pain Severity Subscale of the Brief Pain Inventory in Patients With Low Back Pain：A Systematic Review [J]. J Pain, 2019， 20（3）：245-263.
[16] 梅凌，倪涛，董晓俊，等.腰椎退行性疾病患者行内固定配合椎间植骨融合术后CT影像学效果评价[J].中国CT和MRI杂志，2021，19（4）：144-146.
[17] Jiang C，Yin S，Wei J，et al. Full-Endoscopic Posterior Lumbar Interbody Fusion with Epidural Anesthesia：Technical Note and Initial Clinical Experience with One-Year Follow-Up [J]. J Pain Res，2021，14：3815-3826.
[18] García-Ramos CL，Valenzuela-González J，Baeza-álvarez VB，et al. Lumbar degenerative spondylolisthesis Ⅱ：treatment and controversies [J]. Acta Ortopedica Mexicana，2020， 34（6）：433-440.
[19] Bussières A，Cancelliere C，Ammendolia C，et al. Non- Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication：A Clinical Practice Guideline [J]. J Pain，2021，22（9）：1015-1039.
[20] Fang X，Zhang M，Wang L，et al. Comparison of PLIF and TLIF in the Treatment of LDH Complicated with Spinal Stenosis [J]. J Healthc Eng，2022，2022： 9743283.
[21] Fenton-White HA. Trailblazing：the historical development of the posterior lumbar interbody fusion （PLIF） [J]. Spine J，2021，21（9）：1528-1541.
[22] Fan W，Guo LX，Zhang M. Biomechanical analysis of lumbar interbody fusion supplemented with various posterior stabilization systems [J]. Eur Spine J，2021，30（8）：2342-2350.
[23] 王雅辉，刘正蓬，褚立，等.不同椎间植骨融合方式治疗单节段腰椎管狭窄症的疗效对比[J].实用医学杂志，2019，35（16）：2619-2263.
[24] 祁玉贵.腰椎后路滑脱复位植骨融合内固定术中椎间植骨粒体积与术后融合效果相关性研究[J].中外医疗，2018，37（31）：93-95.
[25] 李鹏飞，贾楠，靳宪辉，等.椎间植骨粒体积对腰椎后路滑脱复位植骨融合内固定术后融合效果的影响[J].中国修复重建外科杂志，2013，27（6）：696-702.
[26] 袁文华.局部自体微粒骨打压植骨与PEEK椎间融合器在腰椎后路椎间融合术中疗效的对比研究[D].兰州：兰州大学，2020.
[27] 郭新虎，孟妍，齐强，等.后路腰椎椎体间融合术后cage移位的危险因素分析及处理策略[J].中国脊柱脊髓杂志，2022，32（1）：42-49.