骨质疏松对颈前路减压椎间融合固定术后相邻节段异位骨化的影响
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摘要
目的:分析骨质疏松对颈前路减压椎间融合(ACDF)术后相邻节段异位骨化的影响。方法:选取2015年1月至2017年1月在辽宁健康产业集团阜新矿总医院行ACDF治疗的120例颈椎病患者,记录患者术前、术后1年骨密度值及术后1年相邻节段异位骨化情况,采用Spearman相关分析法分析术前骨质疏松分级、骨质疏松变化(术后1年与术前骨密度比较)与相邻节段异位骨化的相关性。结果:术后1年无异位骨化(0级)65例,骨化1级35例,骨化2级20例;骨量正常、骨量减少、骨质疏松各组术后1年相邻节段异位骨化严重程度比较差异有统计学意义(P<0.05);Spearman相关分析表明,术前骨质疏松分级(骨量正常、骨量减少、骨质疏松)与患者预后相邻节段异位骨化程度呈正相关关系(r=0.270,P<0.05);结论:术前骨质疏松可能是导致ACDF患者术后相邻节段异位骨化发生的危险因素,抗骨质疏松干预,促骨质疏松缓解可能降低术后相邻节段异位骨化发生率。
Objective:To analyze the effect of osteoporosis on adjacent segmental heterotopic ossification after anterior cervical decompression and fusion(ACDF).Methods:120 patients with cervical spondylosis underwent ACDF in our hospital from January 2015 to January 2017 were selected.The bone mineral density before operation and after one year of operation were measured.Adjacent segmental heterotopic ossification at one year post-operation was recorded.Spearman correlation analysis was performed to analyze the correlation of preoperative osteoporosis grade,osteoporosis changes(comparison of bone mineral density between one year after operation and before operation) and adjacent segmental heterotopic ossification.Results:At one year post-operation,there was no heterotopic ossification(grade 0) in 65 cases,grade 1 ossification in 35 cases and grade 2 ossification in 20 cases.Spearman correlation analysis showed that the preoperative grade of osteoporosis(normal bone mass,osteopenia,osteoporosis) was positively correlated with the degree of adjacent segmental heterotopic ossification(P<0.05).Osteoporosis was unchanged in 51 cases,relieved in 21 cases,and aggravated in 48 cases.The better the osteoporosis changes,the lower the degree of adjacent segmental heterotopic ossification.It means,there was a negative correlation between the osteoporosis changes and the degree of adjacent segmental heterotopic ossification(P<0.05).The bone mineral density decreased significantly with the increase of the grade of heterotopic ossification before operation and at 1 year after operation(P<0.05).Conclusion:Preoperative osteoporosis may be a risk factor for postoperative heterotopic ossification in patients undergoing ACDF.Anti-osteoporosis intervention and osteoporosis relief may reduce the incidence of postoperative adjacent segmental heterotopic ossification.
Objective:To analyze the effect of osteoporosis on adjacent segmental heterotopic ossification after anterior cervical decompression and fusion(ACDF).Methods:120 patients with cervical spondylosis underwent ACDF in our hospital from January 2015 to January 2017 were selected.The bone mineral density before operation and after one year of operation were measured.Adjacent segmental heterotopic ossification at one year post-operation was recorded.Spearman correlation analysis was performed to analyze the correlation of preoperative osteoporosis grade,osteoporosis changes(comparison of bone mineral density between one year after operation and before operation) and adjacent segmental heterotopic ossification.Results:At one year post-operation,there was no heterotopic ossification(grade 0) in 65 cases,grade 1 ossification in 35 cases and grade 2 ossification in 20 cases.Spearman correlation analysis showed that the preoperative grade of osteoporosis(normal bone mass,osteopenia,osteoporosis) was positively correlated with the degree of adjacent segmental heterotopic ossification(P<0.05).Osteoporosis was unchanged in 51 cases,relieved in 21 cases,and aggravated in 48 cases.The better the osteoporosis changes,the lower the degree of adjacent segmental heterotopic ossification.It means,there was a negative correlation between the osteoporosis changes and the degree of adjacent segmental heterotopic ossification(P<0.05).The bone mineral density decreased significantly with the increase of the grade of heterotopic ossification before operation and at 1 year after operation(P<0.05).Conclusion:Preoperative osteoporosis may be a risk factor for postoperative heterotopic ossification in patients undergoing ACDF.Anti-osteoporosis intervention and osteoporosis relief may reduce the incidence of postoperative adjacent segmental heterotopic ossification.
引文
[1] 徐远金,杨俊峰.前路减压植骨融合联合钢板置入内固定治疗脊髓型颈椎病的效果分析[J].颈腰痛杂志,2017,38(6):598-599.
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[11] 陈扬,钱文彬,杨欣建,等.ACDF钢板固定术与ZERO-P内固定术对颈椎病的疗效比较[J].生物骨科材料与临床研究,2014,11(4):36-38,41.
[12] 尚荣安,王少飞,晁建虎,等.两种颈前路减压融合内固定系统治疗颈椎病的疗效比较[J].实用骨科杂志,2016,22(11):961-964.
[13] JOAQUIM A F,MURAR J,SAVAGE J W,et al.Dysphagia after anterior cervical spine surgery:a systematic review of potential preventative measures[J].Spine J,2014,14(9):2246-2260.
[14] 逄川,海涌,杨晋才,等.颈椎前凸角度减小对融合术后邻近节段影响的生物力学研究[J].中华骨科杂志,2016,36(6):353-360.
[2] 尹飞,郭丽,朱庆三,等.前路减压植骨融合术后颈椎相邻节段生物力学变化[J].中华实验外科杂志,2013,30(2):361-362.
[3] 陈昆,刘爱刚,蔡惠民,等.颈前路减压融合术后相邻节段异位骨化的危险因素分析[J].实用骨科杂志,2017,23(3):198-202,216.
[4] 李玉伟,严晓云,王海蛟,等.零切迹椎间融合器在颈椎前路融合术后相邻节段退变中的应用[J].中华外科杂志,2015,53(12):963-965.
[5] 陈文恒,郭团茂,刘强,等.双节段ACDF和单节段ACCF手术治疗脊髓型颈椎病疗效比较[J].实用骨科杂志,2017,23(2):100-104.
[6] KATSUURA A,HUKUDA S,SARUHASHI Y,et al.Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels[J].Eur Spine J,2007,10(4):320-324.
[7] 占蓓蕾,叶舟.颈前路融合术后相邻节段退变120例[J].中国中西医结合外科杂志,2014,20(2):143-145.
[8] 林勇,柴生颋.抗骨质疏松治疗对骨质疏松症患者合并腰椎间盘突出症的防治作用[J].颈腰痛杂志,2017,38(2):124-127.
[9] MIYAKOSHI N,ITOI E,MURAI H,et al.Inverse relation between osteoporosis and spondylosis in postmenopausal women as evaluated by bone mineral density and semiquantitative scoring of spinal degeneration[J].Spine,2003,28(5):492-495.
[10] YANG H,CHEN D,WANG X,et al.Zero-profile integrated plate and spacer device reduces rate of adjacent-level ossification development and dysphagia compared to ACDF with plating and cage system[J].Arch Orthop Trauma Surg 2015,135(6):781-787.
[11] 陈扬,钱文彬,杨欣建,等.ACDF钢板固定术与ZERO-P内固定术对颈椎病的疗效比较[J].生物骨科材料与临床研究,2014,11(4):36-38,41.
[12] 尚荣安,王少飞,晁建虎,等.两种颈前路减压融合内固定系统治疗颈椎病的疗效比较[J].实用骨科杂志,2016,22(11):961-964.
[13] JOAQUIM A F,MURAR J,SAVAGE J W,et al.Dysphagia after anterior cervical spine surgery:a systematic review of potential preventative measures[J].Spine J,2014,14(9):2246-2260.
[14] 逄川,海涌,杨晋才,等.颈椎前凸角度减小对融合术后邻近节段影响的生物力学研究[J].中华骨科杂志,2016,36(6):353-360.