抗骨质疏松治疗预防腰椎滑脱融合术后邻椎病发生的临床研究

Clinical Study on Prevention of Adjacent Vertebral Disease after Lumbar Spondylolisthesis Fusion with Anti-Osteoporosis Therapy

目的:对比分析抗骨质疏松治疗对腰椎滑脱融合术后疗效及邻椎病(ASD)发生的预防效果。方法:2018年1月至2021年6月,采用单节段经椎间孔腰椎椎间融合术(TLIF)治疗Ⅱ度以内退行性腰椎滑脱症合并骨质疏松症患者104例,其中52例进行抗骨质疏松治疗(A组),52例为对照组(B组)。记录两组患者治疗前及治疗后3,6,12个月日本骨科学会(JOA)评分及Oswestry功能障碍指数(ODI),评估腰椎功能并记录两组患者术后24个月内发生邻椎病的时间及例数。结果:两组患者术后各随访时间点JOA评分及ODI均较术前明显改善,差异均有统计学意义(P<0.05)。术后3个月,两组患者JOA评分及ODI改善差异无统计学意义(P>0.05);术后6个月和12个月,A组JOA评分及ODI较B组明显改善,差异有统计学意义(P<0.05)。A组术后24个月内邻椎病出现1例,B组出现5例,但差异无统计学意义(P>0.05)。结论:对于保守治疗效果欠佳的老年退行性腰椎滑脱患者,在围手术期及术后中远期加强抗骨质疏松的治疗,对于术后疼痛症状的改善、脊柱功能的恢复及生活自理能力的提升有较大促进作用,有利于获得更好的长期临床疗效,并且对于术后邻椎病的发生可能起到一定预防作用。

Objective:To compare and analyze the efficacy of anti-osteoporosis treatment on lumbar spondylolisthesis fusion and the prevention effect of adjacent segment degeneration(ASD).Methods:From January 2018 to June 2021,104 patients with degenerative lumbar spondylolisthesis combined with osteoporosis were treated with single-stage transforaminal lumbar interbody fusion(TLIF)of which 52 were treated with anti-osteoporosis therapy(group A)and 52 were treated as control group(group B).The Japanese Orthopaedic Society(JOA)score and Oswestry disability index(ODI)were recorded before treatment and 3,6,and 12 months after treatment in 2 groups to evaluate lumbar function.The occurrence time and number of ASD cases within 24 months after surgery were recorded in both groups.Results:JOA score and ODI were significantly improved at each follow-up time point between the two groups,and the differences were statistically significant(P<0.05).3 months after surgery,there was no significant difference in JOA score and ODI improvement between the two groups(P>0.05).After 6 and 12 months,JOA score and ODI in group A were significantly improved compared with group B,and the difference was statistically significant(P<0.05).There was 1 case of ASD in group A and 5 cases in group B within 24 months after surgery,but the difference was not statistically significant(P>0.05).Conclusion:For elderly patients with degenerative lumbar spondylolisthesis whose conservative treatment is not effective,strengthening anti-osteoporosis treatment in the perioperative period and postoperative medium and long term can greatly promote the improvement of postoperative pain symptoms,the recovery of spinal function,and the improvement of self-care ability,which is conducive to obtaining better long-term clinical efficacy,and the occurrence of postoperative ASD may play a certain preventive role.