自体下关节突骨块辅助腰椎椎间融合术治疗腰椎退行性病变伴骨质疏松症的效果研究

Study on the effects of autologous inferior articular process bone block assisted lumbar interbody fusion in treating degenerative lumbar disease with osteoporosis

摘要:

目的 探讨自体下关节突骨块辅助腰椎椎间融合术（LIF）治疗腰椎退行性病变伴骨质疏松症的临床效果。方法 选取2021年6月—2023年6月黄石市中医医院112例腰椎退行性病变伴骨质疏松症患者，按照分层随机抽样法，将患者分为对照组与试验组，每组56例。对照组接受自体髂骨块为植骨块辅助LIF治疗，试验组接受自体下关节突骨块辅助LIF治疗。对比两组临床指标、疼痛状况［McGill疼痛评估量表（MPQ）评分］、腰椎功能［Oswestry功能障碍指数（ODI）评分、日本骨科协会（JOA）评分］、生活质量［健康状况量表（SF-36）评分］、腰椎前凸角（LL）、节段前凸角（SL）、融合间隙角（DL）、椎间隙高度（DH）、DH改善率、融合率、术后并发症（感染、供区疼痛、神经损伤、移植物后退、移植物塌陷）差异。结果 试验组手术时间和术中出血量均低于对照组（P <0.05）；试验组与对照组术后引流量、腰椎骨密度和住院天数比较，差异均无统计学意义（P >0.05）。试验组与对照组术后1、3、6个月的MPQ、ODI、JOA、SF-36评分比较，结果 ①不同时间点MPQ、ODI、JOA、SF-36评分比较，差异均有统计学意义（P <0.05）；②试验组与对照组MPQ、ODI、JOA、SF-36评分比较，差异均有统计学意义（P <0.05），试验组术后1、3、6个月MPQ、ODI评分均低于对照组，JOA、SF-36评分均高于对照组；③两组MPQ评分变化趋势比较，差异无统计学意义（P >0.05），两组ODI、JOA、SF-36评分变化趋势比较，差异均有统计学意义（P <0.05）。试验组与对照组术后1、3、6个月的LL、SL、DL比较，结果 ①不同时间点LL、SL、DL比较，差异均有统计学意义（P <0.05）；②试验组与对照组LL、SL、DL比较，差异均无统计学意义（P >0.05）；③两组LL、SL、DL变化趋势比较，差异均无统计学意义（P >0.05）。试验组与对照组术后1、3、6个月的DH比较，结果 ①不同时间点DH比较，差异有统计学意义（P <0.05）；②试验组与对照组DH比较，差异无统计学意义（P >0.05）；③两组DH变化趋势比较，差异无统计学意义（P >0.05）。试验组术后1个月DH改善率低于对照组（P <0.05）。试验组与对照组术后3、6个月DH改善率比较，差异均无统计学意义（P >0.05）。试验组术后6个月融合率高于对照组（P <0.05）。试验组并发症总发生率低于对照组（P <0.05）。结论 自体下关节突骨块辅助LIF治疗腰椎退行性病变伴骨质疏松症能够有效改善临床指标和腰椎功能，提高生活质量，减少术后并发症的发生，促进椎体融合，具有显著的临床价值。

Abstract:

Objective To investigate the clinical efficacy of autologous inferior articular process bone block-assisted lumbar interbody fusion (LIF) in the treatment of lumbar degenerative disease with osteoporosis.Methods A total of 112 patients with lumbar degenerative disease and osteoporosis admitted to our hospital from June 2021 to June 2023 were selected and randomly assigned using stratified random sampling to control group (n = 56) and experimental group (n = 56). The control group received autologous iliac bone grafts to assist LIF, while the experimental group received autologous inferior articular process bone grafts to assist LIF. Clinical indicators, pain status [McGill Pain Questionnaire (MPQ) scores], lumbar function [Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores], quality of life [Short Form-36 (SF-36) scores], lumbar lordosis (LL), segmental lordosis (SL), fusion gap angle (DL), intervertebral height (DH), DH improvement rate, fusion rate, and postoperative complications (infection, donor site pain, nerve injury, graft resorption, graft collapse) were compared between the two groups.Results The operative time and intraoperative blood loss were significantly lower in the experimental group than in the control group (P < 0.05). There were no significant differences between the two groups in postoperative drainage volume, lumbar bone mineral density, or length of hospital stay (P > 0.05). Repeated measures ANOVA showed that at 1, 3, and 6 months postoperatively, MPQ, ODI, JOA, and SF-36 scores differed significantly across time points and between groups (P < 0.05); the experimental group had lower MPQ and ODI scores and higher JOA and SF-36 scores than the control group. The trends of MPQ score changes between groups were not statistically different (P > 0.05), but ODI, JOA, and SF-36 score trends differed significantly (P < 0.05). LL, SL, and DL values differed significantly across time points (P < 0.05), but not between groups or in their change trends (P > 0.05). DH values also changed significantly over time (P < 0.05) but showed no significant between-group differences or trend differences (P > 0.05). The DH improvement rate at 1 month postoperatively was significantly lower in the experimental group (P < 0.05), while the DH improvement rate at 3 and 6 months showed no significant difference (P > 0.05). At 6 months, the fusion rate was significantly higher in the experimental group (P < 0.05), while the difference at 3 months was not significant (P > 0.05). The total incidence of complications was significantly lower in the experimental group than in the control group (P < 0.05).Conclusion Autologous inferior articular process bone graft-assisted LIF for lumbar degenerative disease with osteoporosis can effectively improve clinical indicators and lumbar function, enhance quality of life, reduce postoperative complications, promote vertebral fusion, and demonstrates significant clinical value.