维生素D_3对腰椎退变性疾病患者腰椎融合术后腰椎融合率、融合时间及疗效的影响
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摘要
目的探讨维生素D_3对腰椎退变性疾病患者腰椎融合术后腰椎融合率、融合时间及疗效的影响。方法将70例择期行腰椎融合术治疗的维生素D缺乏的腰椎退变性疾病患者随机分为对照组及观察组,每组35例。观察组患者术后即刻及出院后6个月内每月给予肌肉注射10万单位维生素D_3,对照组患者在相同时间给予肌肉注射1 ml生理盐水。比较两组患者腰椎融合时间、术后1周疼痛视觉模拟量表(VAS)评分及术后1年腰椎日本骨科学会(JOA)评分、Oswestry功能障碍指数(ODI)评分、腰椎融合率。结果观察组术后1周VAS评分及术后1年腰椎JOA评分、ODI评分均低于对照组(均P <0. 05);观察组腰椎融合时间短于对照组,术后1年腰椎融合率高于对照组(均P <0. 05)。结论腰椎融合术后肌肉注射维生素D_3可以提高维生素D缺乏腰椎退变性疾病患者的腰椎融合率,缩短融合时间,有效缓解疼痛,改善腰椎功能。
Objective To explore effect of vitamin D_3 on lumbar fusion rate,fusion time and curative effect in patients with lumbar degenerative diseases after lumbar fusion. Methods Seventy lumbar degenerative diseases patients complicated with vitamin D_3 deficiency undergoing elective lumbar fusion were randomly divided into control group or observation group,with 35 cases in each group. Right after operation and monthly within 6 months after discharge,patients in the observation group were given 100,000 units of vitamin D_3 intramuscularly,while patients in the control group were given 1 ml saline intramuscularly instead. Lumbar fusion time,pain Visual Analogue Scale( VAS) score 1 week after operation,and lumbar spine Japanese Orthopaedic Association( JOA) score,Oswestry Dysfunction Index( ODI) score,and lumbar fusion rate 1 year after operation were compared between the two groups.Results VAS score 1 week after operation,JOA score and ODI score of lumbar vertebrae 1 year after operation were lower in the observation group than in the control group( all P < 0. 05). Lumbar fusion time was shorter,and lumbar fusion rate 1 year after operation was higher in the observation group than in the control group( all P < 0. 05). Conclusion Intramuscular injection of vitamin D_3 after lumbar fusion can improve lumbar fusion rate,shorten the fusion time,effectively relieve pain,and improve lumbar function in lumbar degenerative diseases patients complicated with vitamin D deficiency.
Objective To explore effect of vitamin D_3 on lumbar fusion rate,fusion time and curative effect in patients with lumbar degenerative diseases after lumbar fusion. Methods Seventy lumbar degenerative diseases patients complicated with vitamin D_3 deficiency undergoing elective lumbar fusion were randomly divided into control group or observation group,with 35 cases in each group. Right after operation and monthly within 6 months after discharge,patients in the observation group were given 100,000 units of vitamin D_3 intramuscularly,while patients in the control group were given 1 ml saline intramuscularly instead. Lumbar fusion time,pain Visual Analogue Scale( VAS) score 1 week after operation,and lumbar spine Japanese Orthopaedic Association( JOA) score,Oswestry Dysfunction Index( ODI) score,and lumbar fusion rate 1 year after operation were compared between the two groups.Results VAS score 1 week after operation,JOA score and ODI score of lumbar vertebrae 1 year after operation were lower in the observation group than in the control group( all P < 0. 05). Lumbar fusion time was shorter,and lumbar fusion rate 1 year after operation was higher in the observation group than in the control group( all P < 0. 05). Conclusion Intramuscular injection of vitamin D_3 after lumbar fusion can improve lumbar fusion rate,shorten the fusion time,effectively relieve pain,and improve lumbar function in lumbar degenerative diseases patients complicated with vitamin D deficiency.
引文
[1] Deyo RA,Gray DT,Kreuter W,et al. United States trends in lumbar fusion surgery for degenerative conditions[J]. Spine(Phila Pa 1976),2005,30(12):1 441-1 445.
[2] Gray DT,Deyo RA,Kreuter W,et al. Population-based trends in volumes and rates of ambulatory lumbar spine surgery[J].Spine(Phila Pa 1976),2006,31(17):1 957-1 963.
[3] Taylor VM,Deyo RA,Cherkin DC,et al. Low back pain hospitalization. Recent United States trends and regional variations[J].Spine(Phila Pa 1976),1994,19(11):1 207-1 212.
[4] Kalb S,Mahan MA,Elhadi AM,et al. Pharmacophysiology of bone and spinal fusion[J]. Spine J,2013,13(10):1 359-1 369.
[5] Ravindra VM,Godzik J,Guan J,et al. Prevalence of vitamin D deficiency in patients undergoing elective spine surgery:a cross-sectional analysis[J]. World Neurosurg,2015,83(6):1 114-1 119.
[6] Ravindra VM,Godzik J,Dailey AT,et al. Vitamin D levels and 1-year fusion outcomes in elective spine surgery:a prospective observational study[J]. Spine(Phila Pa 1976),2015,40(19):1 536-1 541.
[7]陈佳,李超英,马信龙.椎体终板在椎间融合中的作用和意义[J].中国矫形外科杂志,2013,21(21):2 166-2 168.
[8]黄科昌,黄雪琦,孙兴国.用视觉类比量表法对国人目测能力的观察[J].潍坊医学院学报,1992,14(2):99-101.
[9]郑光新,赵晓鸥,刘广林,等. Oswestry功能障碍指数评定腰痛患者的可信性[J].中国脊柱脊髓杂志,2002,12(1):13-15.
[10]张光铂.对腰椎管狭窄症疗效评定的建议[J].中国脊柱脊髓杂志,1994,4(5):240-241.
[11] Lee JH,Park JW,Lee HS. Fusion rates of a morselized local bone graft in polyetheretherketone cages in posterior lumbar interbody fusion by quantitative analysis using consecutive three-dimensional computed tomography scans[J]. Spine J,2011,11(7):647-653.
[12]漆龙涛,李淳德,张正.腰椎融合术后假关节形成的诊断和手术治疗[J].中国骨与关节杂志,2017,6(11):847-851.
[13] Dede O,Thuillier D,Pekmezci M,et al. Revision surgery for lumbar pseudarthrosis[J]. Spine J,2015,15(5):977-982.
[14] Raizman NM,O'Brien JR,Poehling-Monaghan KL,et al.Pseudarthrosis of the spine[J]. J Am Acad Orthop Surg,2009,17(8):494-503.
[15] Forrest KY,Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults[J]. Nutr Res,2011,31(1):48-54.
[16] Kim TH,Yoon JY,Lee BH,et al. Changes in vitamin D status after surgery in female patients with lumbar spinal stenosis and its clinical significance[J]. Spine(Phila Pa 1976),2012,37(21):E1326-E1330.
[17]汪涛,郭洪刚.椎间融合器Cage无菌性松动相关问题的思索和探讨[J].中国矫形外科杂志,2014,22(17):1 589-1 592.
[18]阿布都外力·赛都拉,阿不都拉·阿不都克依木,麦合木提江·穆海麦提,等.骨质疏松药物治疗在脊柱融合术中的影响[J].国际骨科学杂志,2017,38(6):372-375.
[19] Owens RK 2nd,Djurasovic M,Onyekwelu I,et al. Outcomes and revision rates in normal,overweight,and obese patients5 years after lumbar fusion[J]. Spine J,2016,16(10):1 178-1 183.
[20] Takahashi S,Suzuki A,Toyoda H,et al. Characteristics of diabetes associated with poor improvements in clinical outcomes after lumbar spine surgery[J]. Spine(Phila Pa1976),2013,38(6):516-522.
[21]张萌萌.生命、骨骼、维生素D3[J].中国骨质疏松杂志,2016,22(11):1 496-1 500.
[22] Autier P,Boniol M,Pizot C,et al. Vitamin D status and ill health:a systematic review[J]. Lancet Diabetes Endocrinol,2014,2(1):76-89.
[23]廖祥鹏,张增利,张红红,等.维生素D与成年人骨骼健康应用指南(2014年简化版)[J].中国骨质疏松杂志,2014,20(6):718-722.
[24]周剑锁,张捷.维生素D临床应用研究进展[J].检验医学,2013,28(6):539-543.
[25]陈敏敏,姜鑫,杜艳萍,等.上海社区老年人血清25-羟维生素D水平影响因素的研究[J].中华老年医学杂志,2016,35(9):1 005-1 010.
[26]王怡,刘逸群,刘丽,等. 2型糖尿病患者血清25-羟维生素D3与下肢动脉病变的相关性研究[J].河北医药,2017,39(2):257-260.
[27]吴道爱,王长江,潘攀,等. 25-羟维生素D3和血尿酸与2型糖尿病合并下肢动脉病变的相关性分析[J].中国糖尿病杂志,2017,25(5):429-431.
[28]齐晨蕊.甲亢性骨质疏松症治疗中应用骨化三醇治疗的临床观察[J].中国继续医学教育,2015,5(7):231-232.
[29]李锦军,陈浩,唐海,等.老年骨质疏松人群维生素D缺乏与跌倒风险关系的研究[J].临床和实验医学杂志,2017,16(5):482-485.
[30]曾晓琼.维生素D缺乏与老年认知功能和日常生活能力关系研究[J].九江学院学报:自然科学版,2014,29(1):84-85,88.
[31]张悦,戴永梅,周明,等.孕妇维生素D水平与四肢骨骼肌含量关系的研究[J].公共卫生与预防医学,2016,27(3):121-122,125.
[32]田雪,董捷.血清维生素D与肌肉体积和肌力的关系[J].中华肾脏病杂志,2016,32(9):717-720.
[33]张黎,李燕.活性维生素D3干预高原老年人骨骼肌减少症的相关因素[J].昆明医科大学学报,2016,37(7):53-57.
[34]龚勋,徐胜前,刘文,等.少肌症、维生素D缺乏在类风湿性关节炎合并脊柱骨质疏松性骨折中的临床研究[J].中国骨质疏松杂志,2017,23(2):221-226.
[2] Gray DT,Deyo RA,Kreuter W,et al. Population-based trends in volumes and rates of ambulatory lumbar spine surgery[J].Spine(Phila Pa 1976),2006,31(17):1 957-1 963.
[3] Taylor VM,Deyo RA,Cherkin DC,et al. Low back pain hospitalization. Recent United States trends and regional variations[J].Spine(Phila Pa 1976),1994,19(11):1 207-1 212.
[4] Kalb S,Mahan MA,Elhadi AM,et al. Pharmacophysiology of bone and spinal fusion[J]. Spine J,2013,13(10):1 359-1 369.
[5] Ravindra VM,Godzik J,Guan J,et al. Prevalence of vitamin D deficiency in patients undergoing elective spine surgery:a cross-sectional analysis[J]. World Neurosurg,2015,83(6):1 114-1 119.
[6] Ravindra VM,Godzik J,Dailey AT,et al. Vitamin D levels and 1-year fusion outcomes in elective spine surgery:a prospective observational study[J]. Spine(Phila Pa 1976),2015,40(19):1 536-1 541.
[7]陈佳,李超英,马信龙.椎体终板在椎间融合中的作用和意义[J].中国矫形外科杂志,2013,21(21):2 166-2 168.
[8]黄科昌,黄雪琦,孙兴国.用视觉类比量表法对国人目测能力的观察[J].潍坊医学院学报,1992,14(2):99-101.
[9]郑光新,赵晓鸥,刘广林,等. Oswestry功能障碍指数评定腰痛患者的可信性[J].中国脊柱脊髓杂志,2002,12(1):13-15.
[10]张光铂.对腰椎管狭窄症疗效评定的建议[J].中国脊柱脊髓杂志,1994,4(5):240-241.
[11] Lee JH,Park JW,Lee HS. Fusion rates of a morselized local bone graft in polyetheretherketone cages in posterior lumbar interbody fusion by quantitative analysis using consecutive three-dimensional computed tomography scans[J]. Spine J,2011,11(7):647-653.
[12]漆龙涛,李淳德,张正.腰椎融合术后假关节形成的诊断和手术治疗[J].中国骨与关节杂志,2017,6(11):847-851.
[13] Dede O,Thuillier D,Pekmezci M,et al. Revision surgery for lumbar pseudarthrosis[J]. Spine J,2015,15(5):977-982.
[14] Raizman NM,O'Brien JR,Poehling-Monaghan KL,et al.Pseudarthrosis of the spine[J]. J Am Acad Orthop Surg,2009,17(8):494-503.
[15] Forrest KY,Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults[J]. Nutr Res,2011,31(1):48-54.
[16] Kim TH,Yoon JY,Lee BH,et al. Changes in vitamin D status after surgery in female patients with lumbar spinal stenosis and its clinical significance[J]. Spine(Phila Pa 1976),2012,37(21):E1326-E1330.
[17]汪涛,郭洪刚.椎间融合器Cage无菌性松动相关问题的思索和探讨[J].中国矫形外科杂志,2014,22(17):1 589-1 592.
[18]阿布都外力·赛都拉,阿不都拉·阿不都克依木,麦合木提江·穆海麦提,等.骨质疏松药物治疗在脊柱融合术中的影响[J].国际骨科学杂志,2017,38(6):372-375.
[19] Owens RK 2nd,Djurasovic M,Onyekwelu I,et al. Outcomes and revision rates in normal,overweight,and obese patients5 years after lumbar fusion[J]. Spine J,2016,16(10):1 178-1 183.
[20] Takahashi S,Suzuki A,Toyoda H,et al. Characteristics of diabetes associated with poor improvements in clinical outcomes after lumbar spine surgery[J]. Spine(Phila Pa1976),2013,38(6):516-522.
[21]张萌萌.生命、骨骼、维生素D3[J].中国骨质疏松杂志,2016,22(11):1 496-1 500.
[22] Autier P,Boniol M,Pizot C,et al. Vitamin D status and ill health:a systematic review[J]. Lancet Diabetes Endocrinol,2014,2(1):76-89.
[23]廖祥鹏,张增利,张红红,等.维生素D与成年人骨骼健康应用指南(2014年简化版)[J].中国骨质疏松杂志,2014,20(6):718-722.
[24]周剑锁,张捷.维生素D临床应用研究进展[J].检验医学,2013,28(6):539-543.
[25]陈敏敏,姜鑫,杜艳萍,等.上海社区老年人血清25-羟维生素D水平影响因素的研究[J].中华老年医学杂志,2016,35(9):1 005-1 010.
[26]王怡,刘逸群,刘丽,等. 2型糖尿病患者血清25-羟维生素D3与下肢动脉病变的相关性研究[J].河北医药,2017,39(2):257-260.
[27]吴道爱,王长江,潘攀,等. 25-羟维生素D3和血尿酸与2型糖尿病合并下肢动脉病变的相关性分析[J].中国糖尿病杂志,2017,25(5):429-431.
[28]齐晨蕊.甲亢性骨质疏松症治疗中应用骨化三醇治疗的临床观察[J].中国继续医学教育,2015,5(7):231-232.
[29]李锦军,陈浩,唐海,等.老年骨质疏松人群维生素D缺乏与跌倒风险关系的研究[J].临床和实验医学杂志,2017,16(5):482-485.
[30]曾晓琼.维生素D缺乏与老年认知功能和日常生活能力关系研究[J].九江学院学报:自然科学版,2014,29(1):84-85,88.
[31]张悦,戴永梅,周明,等.孕妇维生素D水平与四肢骨骼肌含量关系的研究[J].公共卫生与预防医学,2016,27(3):121-122,125.
[32]田雪,董捷.血清维生素D与肌肉体积和肌力的关系[J].中华肾脏病杂志,2016,32(9):717-720.
[33]张黎,李燕.活性维生素D3干预高原老年人骨骼肌减少症的相关因素[J].昆明医科大学学报,2016,37(7):53-57.
[34]龚勋,徐胜前,刘文,等.少肌症、维生素D缺乏在类风湿性关节炎合并脊柱骨质疏松性骨折中的临床研究[J].中国骨质疏松杂志,2017,23(2):221-226.
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