单节段棘突间动态稳定装置置入术后1年棘突骨质吸收现象及其风险因素

Bone absorption of spinous process and its risk factors after interspinous dynamic stabilization device implantation one year after operation

中文关键词:  棘突  骨质吸收  棘突间弹性稳定装置  Wallis  风险因素

英文关键词:Spinous process  Bone absorption  Interspinous stabilization device  Wallis  Risk factor

中文摘要:

  【摘要】 目的：研究单节段L4/5棘突间动态稳定装置（Wallis）置入术后1年的L4及L5棘突骨质吸收现象，并行多因素回归分析对可能的原因进行探讨。方法：回顾性研究我科2009年~2011年间行单节段L4/5 Wallis置入手术的患者，通过比较术后1年与术后1周时两组X线片上L4及L5棘突高度、长度及厚度的差异，将患者分为两组：骨质吸收组与非骨质吸收组。比较两组患者性别、年龄、BMI、是否吸烟、骨质疏松、手术时间、术中出血量、腰背肌肉锻炼、佩戴腰围时间、L4/5棘突间距、L4/5椎间隙高度及腰椎前凸角度，并于术前及术后1年通过腰椎MRI对腰椎间盘退变程度进行分级以及对症状进行VAS、JOA、ODI评分。应用卡方检验、T检验及二分类多因素回归分析进行统计分析。结果：完成随访患者44例，男24例，女20例，平均年龄42.7岁。有29例发生骨质吸收，女性16例，占55.2%，其中L4和L5同时发生骨质吸收者16例，以L4、L5棘突高度骨质吸收最为严重，骨吸收率分别为（16.28±1.46）%、（22.93±1.63）%。术前存在骨质疏松的患者共7例，均发生了骨质吸收。棘突骨质吸收的独立危险因素有BMI（OR：1.337，95% CI：1.048～1.705），30°<术前腰椎前凸角≤40°（OR：8.953，95% CI：1.011～79.269），40°<术前腰椎前凸角≤50°（OR：11.160，95% CI：1.112～111.961），术前腰椎前凸角>50°（OR：11.718，95% CI：1.535～89.436）；两组患者MRI、VAS、JOA及ODI评分比较无显著统计学差异（P>0.05）。结论：棘突间弹性内固定装置Wallis置入术后1年可观察到棘突的骨质吸收现象，该现象较为普遍并存在一定规律，患者术前BMI及腰椎前凸角度是其独立风险因素，骨质疏松也是其可能的原因之一，但是该现象与术后症状是否缓解及影像学改变无显著关联。

英文摘要:

  【Abstract】 Objectives: To investigate the bone absorption of L4 and L5 spinous process at 1 year post-operation and its risk factors. Methods: Patients from 2009 to 2011 in our department undergoing L4/5 Wallis implantation were reviewed retrospectively. According to the bone absorption rate meassured from the height, length and width of L4 and L5 spinous process on one-week and one-year X-ray image, patients were divided into two groups: Bone absorption group and Non bone absorption group. The patients′ gender, age, BMI, smoking, osteoporosis, operation time, blood loss, low back muscle exercise, time of brace applied, height of preoperative L4/5 interspinous space, height of preoperative L4/5 disc space and LL, and disc degeneration grade measured by preoperative and 1-year postoperative magnetic resonance image(MRI) as the VAS, JOA and ODI score. Chi-square test, T-test and Binary logistic regression analysis were compared between 2 groups. Results: 44 patients completed the one-year follow-up, there were 24 males and 20 females, with an average age of 42.7 years. 29 patients had bone absorption, of them, 16 were women(55.2%), 16 patients had both L4 and L5 spinous process bone absorption simultaneously. Severe bone absorption occurred at the height of L4 and L5 spinous process, with an absorption rate of (16.28±1.46)% and (22.93±1.63)% respevtively. 7 patients with preoperative osteoporosis all showed bone absorption. Independent risk factors for bone absorption were: preoperative BMI(odds ratio[OR]: 1.337, 95% confidence interval[CI]: 1.048-1.705), 3050 (OR:11.718, 95% CI:1.535-89.436). MRI, VAS, JOA and ODI had no statistically significant differences between the two groups(P>0.05). Conclusions: Bone absorption after Wallis implantation can be observed one year after operation, Preoperative BMI and LL are independent risk factors, osteoporosis is also one of the possible causes. However, there is no significant association between the onset of this phenomenon with postoperative symptoms.