骨密度对斜侧方入路椎体间融合术治疗腰椎退行性滑脱症疗效的影响

Effect of bone mineral density on the clinical efficacy of oblique lateral interbody fusion in the treatment of lumbar degenerative spondylolisthesis

中文关键词:  腰椎退行性滑脱症  骨密度  经斜侧方入路椎体间融合术  融合率  临床疗效  椎间隙高度

英文关键词:Lumbar degenerative spondylolisthesis  Bone mineral density  Oblique lumbar interbody fusion  Fusion rate  Clinical efficacy  Intervertebral disc height

中文摘要:

  【摘要】 目的：分析骨密度对斜侧方入路椎体间融合术（oblique lateral interbody fusion，OLIF）治疗腰椎退行性滑脱症疗效的影响。方法：回顾性分析2017年12月~2020年7月期间我科在脊柱微创通道系统辅助下OLIF治疗的Meyerding Ⅰ级腰椎退行性滑脱症患者的临床资料。根据患者术前骨密度分为低骨量组（-2.5

英文摘要:

  【Abstract】 Objectives: To analyze the clinical effect of bone mineral density(BMD) on the efficacy of oblique lateral interbody fusion(OLIF) in the treatment of lumbar degenerative spondylolisthesis(LDS). Methods: A retrospective analysis was conducted on the clinical data of patients with Meyerding grade Ⅰ LDS who underwent OLIF assisted with a minimally invasive spinal channel system between December 2017 and July 2020. Based on the preoperative BMD, the patients were divided into low bone mass group(-2.50.05). The operative time, intraoperative blood loss, ambulation time after surgery, length of hospital stay, and complications were collected and compared between the two groups. The postoperative 1 week reduction rate of spondylolisthesis, and postoperative 1 month improvement in spinal canal cross-sectional area, and intervertebral disc height restoration were counted and compared; Bone graft fusion was observed of the two groups of patients on X-ray images at 3 months, 6 months, and 12 months of follow-up after operation. The Japanese Orthopaedic Association(JOA) scores were assessed at pre-operation, and 1, 3, 6 and 12 months after operation, and JOA score at 12 months after operation was used to determine the improvement rate of JOA score. Results: Comparing with the osteoporosis group, the low bone mass group was shorter in operative time(119.5±12.7min vs. 163.3±14.2min), less in intraoperative blood loss(98.9±22.4mL vs. 211.5±29.8mL), shorter in ambulation time after surgery(2.3±0.9d vs. 3.9±1.2d) and length of hospital stay(6.2±1.3d vs. 8.9±1.6d)(P<0.05). At 1 week postoperatively, complete reduction was observed in 29 cases(96.7%) in the low bone mass group and 15 cases(68.2%) in the osteoporosis group. There was a statistically significant difference in the reduction outcomes between the two groups(P<0.05). After OLIF treatment, statistically significant differences were noted between the postoperative dural sac cross-sectional area and the intervertebral disc height and the preoperative values, respectively(P<0.05). The recovery of intervertebral disc height of the osteoporosis group was significant different from that of the low bone mass group (12.79±0.99mm vs. 11.25±0.98mm, P<0.05), while the improvement of the dural sac cross-sectional area was not(P>0.05). The fusion rates were not significantly different between the two groups(93.3% vs 77.3%, P>0.05). The JOA scores at 1 month and 3 months after surgery in the low bone mass group were statistically significant different from those of the osteoporosis group(P<0.05), while the JOA scores at 6 and 12 months after surgery were not significantly different between the two groups(P>0.05). Conclusions: OLIF can achieve satisfactory short-term clinical outcomes in low bone mass and osteoporosis LDS patients, and its efficacy is better in patients with low bone mass than patients with osteoporosis.