阿仑膦酸钠与鲑鱼降钙素对腰椎后路椎间融合术后疗效的比较研究

A comparative study of curative effects on alendronate sodium versus salmon calcitonin after posterior lumbar interbody fusion

目的探讨阿仑膦酸钠与鲑鱼降钙素对椎间融合临床疗效的差异。方法回顾性分析我科自2010年9月～2012年8月间治疗168例腰椎管狭窄合并腰椎间盘突出症患者资料,所有患者均行椎弓根螺钉固定、后路椎间融合术。依照PLIF术后用药的不同将患者机分为阿仑膦酸钠组(A组,n=51),鲑鱼降钙素组(B组,n=52)和对照组(C组,n=65,不使用任何抗骨质疏松及补钙药物)。比较患者的基本情况、临床效果和影像学结果(融合率和手术节段椎间隙高度的变化)。结果术后随访半年～2年1个月,平均18个月。A、B、C组三组的优良率分别为88.2%、88.5%、61.5%,A、B组优良率均较对照组明显提高,但A、B组间优良率差异无显著性意义;A组和B组在手术时间、失血量以及住院时间上差异也无显著性。术后1年随访时融合率A组为84.3%,B组84.6%,C组53.8%,A、B组均高于C组,A、B组间比较差异无显著性意义。三组患者术后椎间隙高度均有不同程度的丢失,A组1.1(0.6～1.9)mm、B组1.1(0.8～2.1)mm,两组间比较差异无显著性意义,但A、B组椎间隙高度丢失程度均较对照组C组4.0(1.9～4.9)mm明显降低。结论腰椎后路椎间融合术(PLIF)术后规范使用阿仑膦酸钠或鲑鱼降钙素能够获得令人满意的临床效果,具有较高的椎间植骨融合率及较少的椎间隙高度丢失。

Objectives To study the curative effects of alendronate sodium versus salmon calcitonin in promoting interbody fusion after posterior lumbar interbody fusion （PLIF）. Methods From September 2010 to August 2012,168 patients with adult lumbar spinal stenosis associated with prolapse of lumbar intervertebral disc were treated with posterior lumbar interbody fusion and pedicle screw fixation. The patients were divided into 3 groups according to the drugs used after PLIF, alendronate sodium group （group A,n=51）, salmon calcitonin group （group B, n=52） and controls （n=65, without taking any anti-osteoporosis drugs. The clinical and imaging results of the patients were compared among three groups. Results All patients were followed up from 6 months to 2 years and 1 month （an average of 18 months ） .There were no significant differences between two groups regarding the surgical time, blood loss and hospital stay. No severe complication occurred in the 3 groups.The rates of excellent,good and fair were 88.2% ,88.5% and 61.5% in group A, B and C respectively. There were no significant difference between group A and B, but both group A and B were significantly higher than that in group C. One year post-operatively,the fusion rate were 84.3%, 84.6% and 53.8% in group A,B and C respectively. There were no significant difference between group A and B, but both group A and B were significantly higher than in group C.The average loss of disc space height were 1.1 mm, 1.1 mm and 4.0 mm in group A,B and C respectively. There were no significant difference between group A and B, but both Group A and B were significantly lower than in group C. Conclusions Administration of alendronate sodium or salmon calcitonin after PLIF is beneficial to promoting interbody fusion rate and reducing loss of disc space height.