绝经后骨质疏松症对颈后路椎板成形术的影响  

The effect of postmenopausal osteoporosis on posterior cervical laminoplasty

作　　者：樊清馨 贾宇涛[2] 刘洋[2] 贺超 李玉乔 孙天威[2] FAN Qing-xin;JIA Yu-tao;LIU Yang;HE Chao;LI Yu-qiao;SUN Tian-wei(Graduate School,Tianjin Medical University,Tianjin 30070,China;Department of Spinal Surgery,Tianjin Union Medical Center,Tianjin 300131,China)

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市人民医院脊柱外科,天津300131

出　　处：《天津医科大学学报》2020年第4期370-373,共4页Journal of Tianjin Medical University

基　　金：天津市自然科学基金资助项目(18JCYBJC28200);天津市人民医院科研项目资助(2019JZPY02)。

摘　　要：目的:探讨绝经后骨质疏松症(PMOP)对于颈后路椎板成形术治疗效果的影响。方法:回顾性分析2013年1月—2017年6月我院行颈后路椎板成形术并完成两年随访的173例绝经女性患者临床资料,年龄52~80岁,平均(63.23±10.73)岁。根据是否存在PMOP,将患者分为绝经后骨质疏松组(PMOP,n=62)、非绝经后骨质疏松组(non-PMOP,n=111)。收集并分析两组术前基本资料和并存疾病的情况,并通过平片与CT评估患者锚钉松动以及钛板位移情况,采用视觉模拟量表(VAS)、颈椎功能障碍指数(NDI)、颈椎活动度(ROM)以及日本骨科协会评估治疗分数(JOA),评估两组患者的手术预后情况。结果:PMOP组血镁及25-(OH)D浓度较non-PMOP组低(P<0.001),β-CTX、TPINP与PTH较non-PMOP组升高(均P<0.001)。PMOP患者在术前更容易存在合并症,以高血压(72.58%,χ^2=15.471,P<0.001)、高血脂(61.29%,χ^2=15.39,P<0.001)以及糖尿病(59.68%,χ^2=31.25,P<0.001)最为显著。术中,PMOP患者手术时间更短[(94.76±36.26)min vs.(122.73±25.4)min,P=0.022]。术后,PMOP患者更容易出现锚钉松动(P=0.029)以及钛板移位(P=0.036),然而在临床效果评价(VAS、JOA、NDI、ROM以及C5神经根麻痹)方面,两组差异无统计学意义。结论:PMOP患者在术前更可能合并其他系统疾病,行颈后路椎板成形术的时间更短,术后锚钉松动与钛板移位率增加,在治疗效果方面没有明显差异。Objective:To explore the effect of postmenopausal osteoporosis(PMOP)on the prognosis of laminectomy.Methods:A total of 173 patients who underwent laminoplasty and completed two-year follow-up were enrolled.The age of surgery ranged from 52 to 80 years,with an average age of(63.23±10.73)years.According to whether PMOP was present,the patient was divided into PMOP group(OP,n=62)and non-PMOP group(non-OP,n=111).The demographic information,preoperative comorbidities and evaluate the cervical range of motion(ROM),loosening of the anchor screw and displacement of the titanium plate were collected and analyzed by plain film and CT.The Visual Analogue Scale(VAS),Neck Disability Index(NDI),and Japanese Orthopaedic Association score(JOA)were used to evaluate the surgical outcomes of the patients.Results:The concentrations of serum magnesium and 25-(OH)D in the PMOP group were lower than non-OP group(P<0.001),and the concentrations of TPINP and PTH in the PMOP group were higher than those in non-OP group(P<0.001).The PMOP patients were more likely have comorbidities before surgery,hypertension(72.58%,χ^2=15.471,P<0.001),hyperlipidemia(61.29%,χ^2=15.39,P<0.001)and diabetes(59.68%,χ^2=31.25,P<0.001)were the most significant diseases.During the operation,the operation time in the osteoporosis group was shorter than non-OP group(94.76±36.26)min vs.(122.73±25.4)min,P=0.022].In addition,PMOP patients were more prone to occur screw loosening(P=0.029)and titanium plate displacement(P=0.036),however,there were no significant differences in clinical effect(VAS,JOA,NDI,ROM and C5 palsy).Conclusion:PMOP patients are more likely to have other diseases,shorter operation time and lower anchor screw loosening and titanium plate displacement rate,but the clinical effects are no significantly difference.

关 键 词：绝经后骨质疏松症 颈椎 椎板成形术 预后 

分 类 号：R681.5[医药卫生—骨科学]