维生素D对维生素D缺乏患者ACCF术的影响

doi:10.3969/j.issn.1000-8535.2020.03.014

摘要/Abstract

摘要： 目的探讨维生素D对维生素D缺乏患者ACCF术后钛网下沉及临床疗效的影响。方法 70例行ACCF术治疗的维生素D缺乏患者,按随机数字表法将患者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每月给予肌肉注射10万U维生素D₃,持续6个月,对照组患者则给予肌肉注射1 mL生理盐水。比较两组颈椎融合时间、钛网下沉率、术后1年颈椎JOA评分、NDI评分。结果观察组术后1年颈椎JOA评分、NDI评分均优于对照组(均P＜0.05);观察组钛网下沉率低于对照组,颈椎融合时间短于对照组(均P＜0.05)。结论补充维生素D可以缩短维生素D缺乏患者的ACCF术后融合时间、减少钛网下沉、改善临床疗效。

关键词: 维生素D, 颈椎融合时间, 钛网下沉

Abstract: Objective To investigate the effect of vitamin D on titanium mesh subsidence and clinical efficacy in patients with vitamin D deficiency after ACCF. Methods Seventy patients with vitamin D deficiency treated by ACCF were divided into control group and observation group according to random number table method, 35 cases in each group. Patients in the observation group were given intramuscular injection of 100 000 U of vitamin D₃ immediately after operation and after discharge for 6 months, while patients in the control group were given intramuscular injection of 1 mL of normal saline. The time of cervical fusion, the subsidence rate of titanium mesh, the JOA score and NDI score of cervical spine 1 year after operation were compared between the two groups. Results The JOA score and NDI score of cervical vertebra in the observation group were better than those in the control group one year after operation(P<0.05);the subsidence rate of titanium mesh in the observation group was lower than that in the control group, and the fusion time of cervical vertebra was shorter than that in the control group(P<0.05). Conclusion Vitamin D supplementation may shorten the fusion time of patients with vitamin D deficiency after ACCF, reduce the sinking of titanium mesh and improve the clinical efficacy.

Key words: Vitamin D, Fusion time of cervical spine, Titanium mesh subsidence

李文升, 李瑞龙. 维生素D对维生素D缺乏患者ACCF术的影响[J]. 广州医药, 2020, 51(3): 61-64.

LI Wensheng, LI Ruilong. Effect of vitamin D on ACCF in patients with vitamin D deficiency[J]. Guangzhou Medical Journal, 2020, 51(3): 61-64.

参考文献

[1] 张静涛. 颈椎退变性疾病手术疗效影响因素的相关研究[D]. 河北医科大学,2017.
[2] 黄建军,王小勇,张涛,等. 钛网与自体髂骨应用于颈椎前路手术的研究[J]. 中国矫形外科杂志,2015,23(23):2123-2127.
[3] WANG S J, HAN Y C,LIU X M, et al. Fusion techniques foradult isthmic spondyl01 isthesis: a systematic review [J]. Arch Orthop Trauma Surg, 2014, 134(6): 777-784.
[4] ISLAM M A,ISLAM M A, HABIB M A,et al. Anterior cervicaldiscectomy,fusion and stabilization by plate and screw: earlyexperience [J]. Bangladesh Med Res Counc Bull, 2012, 38(2): 62-66.
[5] KALB S, MAHAN M A, EIHADI A M, et al. Pharmacophysiology of bone and spinal fusion[J]. Spine,2013,13(10):1359-1369.
[6] RAVINDRA V M, 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):1114-1119.
[7] RAVINDRA V M, GODZIK J, DAILEY A T, et al. Vitamin D levels and 1-year fusion outcomes in elective spine surgery: a prospective observational study[J]. Spine, 2015,40(19):1536-1541.
[8] 翟鹏飞,刘伟,孙志明,等. 经前路颈椎椎体次全切除钛网置入融合后相邻节段的退变[J]. 中国组织工程研究,2016,20(35):5216-5223.
[9] 覃浩然,覃海飚,钟远鸣,等. 前路MC+颈椎融合器植入治疗颈椎间盘突出症[J]. 华夏医学,2017,30(1):100-102.
[10] 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):2166-2168.
[11] van JONBERGEN H P,SPRUIT M,ANDERSON P G,et al. Anteriorcervical interbody fusion with a tit anium box cage: early radiological assessment of fusion and subsidence [J]. Spine J,2005, 5(6): 645-649.
[12] RAIZMAN N M, O'BRIEN J R, POEHLING-MONAGHAN K L, et al. Pseudarthrosis of the spine[J]. J Am Acad Orthop Surg,2009,17(8):494-503.
[13] 张静涛. 颈椎退变性疾病手术疗效影响因素的相关研究[D]. 河北医科大学,2017.
[14] HAN Y C,LIU Z Q,WANG S J,et al. Is anterior cervical dis-cectomy and fusion superior to corpectomy and fusion fortreatment of multilevel cervical spondylotic myelopathy?A systemic review and meta-analysis[J]. PLo S One,2014,9(1):e87191.
[15] PARK Y,MAEDA T,CHO W,et al. Comparison of anteriorcervical fusion after two-level disce ctomy or single-levelcorpectomy:Sagittal alignment,cervical lordosis,graft collapse,and adjacent-level ossification[J]. Spine J,2016,10(3):193-199.
[16] 李海东,张强华,何守玉,等. ACCF与ACCF治疗双节段脊髓型颈椎病的中期疗效及并发症随访分析[J]. 中国现代医生,2018,56(28):18-22,26.
[17] KORINTH M C. Treatment of cervical degenerative disease:current status and rends[J]. Zentralbl Neurochir,2018,69(3):113-124.
[18] FRASER J F,HART R. Anterior approaches to fusion of the cervical spine:a metaanalysis of fusion rates[J]. J Neurosurg Spine,2017,6(4):298-303.
[19] BILBAO G,DUART M,AURRECOECHEA J J,et al. Surgical results and complications in a series of 71 consecutive cervical spondylotic corpectomies[J]. Acta Neurochirurgica,2010,152(7):1155-1163.
[20] 吴东荣,郭涛. 颈前路椎体次全切术后钛网下沉原因分析及对策研究进展[J]. 中国脊柱脊髓杂志,2018,28(9):846-850.
[21] CHEN Y,LEE J K,LEE J H,et al. Effect of posterior subsidence on cervical alignment after anterior cervical corpectomy and reconstruction using titanium mesh cages in degenerative cervical disease[J]. J Clin Neurosci, 2014,21(10):1779-1785.
[22] 孙志峰,何斌,蒋建新. 两种颈椎前路减压融合术治疗多节段颈椎病[J]. 中国骨与关节损伤杂志,2013,28(3):240-241.
[23] 黎宁,侯树兵,孙先泽,等. 多节段脊髓型颈椎病前路手术中期疗效的分析研究[J]. 河北医药,2015,17(8):1198-1200.
[24] 潘孟骁,陈德玉,陈宇. 颈椎前路椎体次全切除后钛网下沉原因及对颈神经功能的影响[J]. 中国组织工程研究,2017,21(15):2355-2360.
[25] 黄笃,康照利,邹三明,等. 颈椎前路椎体次全切除术后钛网下沉的原因分析及其对疗效的影响[J]. 颈腰痛杂志,2019,40(1):36-39.
[26] 王俊波,王文军,刘进才,等. 颈椎术后钛网沉陷的影像学表现及相关影响因素[J]. 中南医学科学杂志, 2014,42(1):66-69.
[27] CHOU Y C,CHEN D C,HSIEH W A,et al. Efficacy of anteriorcervical fusion:comparison of titanium cages,polyethere-therketone(PEEK) cages and autogenous bone grafts[J]. J Clin Neurosci,2018, 15(11):1240-1245.
[28] KAZUHIRO H A, MASASHI A, TOSHIKATSU W, et al. An experimental study on the interface strength between titanium mesh cage and vertebra in reference to vertebral bone mineral density[J]. Spine,2001,26(8):957-963.
[29] 彭立军,羊明智,刘骞,等. 颈椎前路椎体次全切除术后钛网下沉的原因分析[J]. 颈腰痛杂志,2016,37(3):210-213.
[30] FORREST K Y, STUHLDREHER W L. Prevalence and correlates of vitamin D deficiency in US adults[J]. Nutr Res,2011,31(1):48-54.
[31] 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.
[32] 张萌萌. 生命、骨骼、维生素D3[J]. 中国骨质疏松杂志,2016,22(11):1496-1500.
[33] 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.
[34] 廖祥鹏,张增利,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.
[35] 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):1005-1010.
[36] 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.
[37] 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.
[38] 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.
[39] 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.