老年人骨质疏松对腰椎短节段经椎间孔椎间融合术疗效的影响

The impact of osteoporosis on the clinical efficacy of short-segment transforaminal lumbar interbody fusion in elderly patients

目的研究老年人骨质疏松对腰椎短节段经椎间孔椎间融合术疗效的影响。方法回顾性分析2016年5月至2018年5月北京医院行腰椎内固定经椎间孔椎间融合术(TLIF)手术的老年患者,按照骨密度分为骨质疏松组(OP组)75例、骨密度T≤-2.5,对照组(CO组)103例、骨密度T>-1.0;比较两组患者基本信息和临床资料、以及术后随访临床评价结果。结果最终纳入178例老年患者其中腰椎间盘突出68例、腰椎管狭窄110例。术前OP组和CO组的腰痛视觉模拟评分(VAS)(7.35±1.30)分、(7.35±1.33)分,腿痛VAS评分(7.32±1.30)分、(7.22±1.40)分,两组术前腰痛、腿痛VAS评分差异均无统计学意义(t=0.140、0.468,P=0.989、0.640);OP组的术后Cage(椎间融合器)塌陷比例70.7%(53/75)、术后螺钉松动比例37.3%(28/75),明显高于CO组22.3%(23/103)、14.6%(15/103)(χ^(2)=41.440、12.280,均P=0.000);而OP组和CO组患者的术后1年、2年椎间融合率差异均无统计学意义[术后1年:89.3%(67/75)比91.3%(94/103)、χ^(2)=0.187、P=0.666,术后2年:94.6%(71/75)比95.1%(98/103)、χ^(2)=0.021、P=0.885]。OP组和CO组腰痛、腿痛VAS评分以及功能障碍指数(ODI)在术后6个月、1年和2年的差异均无统计学意义(均P>0.05)。结论虽然存在Cage塌陷、内固定松动等骨质疏松相关并发症,但老年骨质疏松患者行腰椎短节段TLIF手术仍能获得较好的效果。

Objective To investigate the impact of osteoporosis on clinical outcomes in elderly patients treated with short segment transforaminal lumbar interbody fusion.Methods From May 2016 to May 2018,elderly patients who had undergone transforaminal lumbar interbody fusion(TLIF)in our hospital were retrospectively analyzed.Based on bone mineral density(BMD),patients were divided into the osteoporosis group(the OP group,n=75,T≤-2.5 in BMD)and the control group(the CO group,n=103,T>-1.0 in BMD).General patient information,clinical data and postoperative follow-up clinical results were compared between the two groups.Results Eventually 178 cases were enrolled,including 68 with lumbar disc herniation and 110 with lumbar spinal stenosis.Preoperative Visual Analogue Scale(VAS)scores were 7.35±1.30 in the lower back and 7.32±1.30 in the leg for the OP group and 7.35±1.33 and 7.22±1.40,respectively,for the CO group,and there was no significant difference between the two groups(t=0.140 and 0.468,P=0.989 and 0.640).The proportions of cage collapse and internal fixation loosening were 70.7%(53/75)and 37.3%(28/75)in the OP group,which were higher than 22.3%(23/103)and 14.6%(15/103)in the CO group(χ^(2)=41.440 and 12.280,both P=0.000).However,there was no significant difference between the OP group and the CO group in 1-and 2-year postoperative interbody fusion rates(postoperative 1-year rate:89.3%or 67/75 vs.91.3%or 94/103,χ^(2)=0.187,P=0.666;postoperative 2 year rate:94.6%or 71/75 vs.95.1%or 98/103,χ^(2)=0.021,P=0.885.There was no significant difference in VAS score and Oswestry disability index(ODI)between the OP group and the CO group at 6 months,1 year and 2 years after surgery(all P>0.05).Conclusions Although there are some osteoporosis-related complications such as cage subsidence and screw loosening,short-segment TLIF can still achieve good clinical results in elderly patients with osteoporosis.