骨质疏松相关因素对腰椎退变性疾病患者内固定手术预后的影响

Effect of osteoporosis-related factors on clinical outcomes of internal fixation in patients with lumbar degenerative diseases

目的探讨骨质疏松相关因素对腰椎退变性疾病患者内固定手术临床疗效的影响。方法回顾性分析87例腰椎退变性疾病行内固定手术患者的临床资料,采用亚洲人骨质疏松自我筛查工具(OSTA)评估骨质疏松危险性,视觉模拟评分法(VAS)、Oswestry功能障碍指数(ODI)、欧洲五维健康量表(EQ-5D)及EQ-VAS评估临床疗效。结果 87例患者末次随访时VAS评分、ODI评分、EQ-5D评分、EQ-VAS评分和OSTA指数分别为(1.76±2.09)分、(12.24±13.77)分、(0.79±0.09)分、(78.92±12.83)分和0.93±2.84。骨质疏松低风险63例,中风险23例,高风险1例。病种、OSTA指数与内固定术后VAS、ODI、EQ-5D、EQ-VAS评分均无明显相关(P>0.05)。45例行椎间融合术患者的年龄与VAS、ODI和EQ-5D评分相关(rs=0.380、0.447和-0.506,P<0.05或P<0.01),体重与ODI评分相关(rs=0.295,P<0.05),OSTA指数与ODI、EQ-5D评分相关(rs=-0.484、0.632,P<0.01);而42例未行椎间融合术患者的骨质疏松相关因素与手术预后无明显相关(P>0.05)。结论随着年龄、体重以及骨质疏松风险因素的增高,腰椎退变性疾病患者行椎间植骨融合内固定术后的短期临床疗效越差。

Objective To investigate the effect of osteoporosis-related factors on clinical outcomes of internal fixation in patients with lumbar degenerative diseases.Methods The clinical data of 87 patients with lumbar degenerative diseases underwent internal fixation were retrospectively analyzed.The risk of osteoporosis was assessed by osteoporosis self-assessment tool for Asians（OSTA）.And the clinical efficacy was evaluated by visual analogue score（VAS）,Oswestry disability index（ODI）,European quality of life-5dimensions（EQ-5D）and EQ-VAS.Results VAS,ODI,EQ-5D and EQ-VAS scores of 87 patients were（1.76±2.09）points,（12.24±13.77）points,（0.79±0.09）points and（78.92±12.83）points,and OSTA index was 0.93±2.84.Low risk of osteoporosis was assessed in 63 cases,medium risk in 23 cases,and high risk in one case.The disease entity,OSTA index were not significantly correlated to VAS,ODI,EQ-5Dand EQ-VAS scores after internal fixation（P〈0.05）.In 45 patients underwent intervertebral fusion,age was correlated with VAS,ODI and EQ-5Dscores（rs=0.380,0.447and-0.506,P〈0.05 or P〈0.01）,body weight was correlated with ODI（rs=0.295,P〈0.05）,and OSTA index was correlated with ODI and EQ-5D scores（rs=-0.484 and 0.632,P〈0.01）.However,there was no significant association between osteoporotic factors and postoperative prognosis in 42 patients without intervertebral fusion（P〈0.05）.Conclusion The short-term clinical efficacy of internal fixation with intervertebral fusion in the treatment of lumbar degenerative diseases may get worse as age,body weight and risk of osteoporosis are increased.