| Background:Lumbar spinal stenosis(LSS)with intervertebral instability is a degenerative disease of the spine.The spinal canal stenosis caused by intervertebral instability and compresses the spinal nerves.There is lumbar pain,lower limb radiation pain,limb numbness A clinical syndrome of indirect lameness.The stability of the lumbar spine segment is dominated by a variety of tissues around the vertebral body,including the intervertebral disc,ligamentum flavum,paravertebral muscles,and upper and lower articular processes;when the degeneration of the lumbar spine appears on the facet plane,it can cause the lumbar disc degeneration,which changes the height of the intervertebral space and the stress of the spine,and ultimately leads to intervertebral instability;intervertebral instability can lead to spinal stenosis.This shows that the key to treating LSS and intervertebral instability is to relieve spinal cord compression and restore spinal stability.Clinical treatment of this disease often takes conservative treatment,such as wearing a waist orthosis,medical treatment,spinal nerve block and physical therapy;only patients who fail conservative treatment will undergo surgical treatment;surgical treatment of patients with LSS and intervertebral instability at this stage The plan includes spinal nerve root decompression,pedicle screw(PS)system fixation,and lumbar interbody fusion.The early spinal activity in the postoperative period is supported by the internal fixation of the PS system,and the main force of the late spinal activity is still supported by the bony fusion of the lumbar spine.With the gradual intensification of China’s aging,more and more elderly people suffer from osteoporosis.Osteoporosis(OP)is characterized by decreased bone mineral density(BMD)and changes in bone microstructure;OP mainly affects the cancellous bone of the patient’s bones,resulting in sparse trabecular bone and increased bone brittleness.When patients with OP need surgical treatment for lumbar degenerative diseases,the fixation strength of PS in the loose vertebral body is greatly reduced,and screw loosening and extraction are likely to occur after surgery;in order to solve this problem,domestic and foreign scholars have proposed many Solutions for improving PS,such as increasing the length of the screw,increasing the diameter of the screw,improving the design of the screw thread and the combination of bone cement reinforcement technology.This study intends to use double-thread screw internal fixation combined with 360 ° intervertebral fusion(posterior approach is used for bone graft fusion of lumbar intervertebral and articular processes and spinous processes to form intervertebral ring fusion)and injectable cement pedicle screw internal fixation combined with 360 ° intervertebral fusion for the treatment of elderly patients with intervertebral instability and LSS.By comparing the difference between the preoperative and postoperative treatment effects between the two groups of patients,the results are statistically analyzed and discussed,hoping to provide a reference for the clinician in the choice of surgery.Purpose:To explore the better treatment methods for the elderly patients with intervertebral instability and lumbar spinal stenosis,and hope that in some cases,they can provide a reference for the clinician’s choice of surgery.Method:From September 2017 to March 2019,72 cases of elderly patients with intervertebral instability and LSS who underwent surgical treatment in the orthopedic ward of the First Affiliated Hospital of Henan University.In group A(control group),37 patients in the group with double-threaded pedicle screw fixation combined with 360 ° interbody fusion;group B(observation group),35 patients in the group with injectable cement pedicle screw fixation combined with 360 ° interbody fusion.By comparing the preoperative and postoperative VAS,ODI score and JOA score between the two groups of patients;postoperative reexamination of lumbar spine DR,CT,observing the shape of the spine,and judging whether the double-threaded pedicle screw and the injectable cement pedicle screw loosened,Shedding,etc.measured the height of the lumbar intervertebral space and compared with preoperatively and evaluated the fusion rate of intervertebral bone grafting,and comprehensively evaluated the curative effect of the two surgical methods.Result:1.Comparison of general conditions of patients: age was analyzed by t test,P = 0.932(P> 0.05);gender was analyzed by chi-square test,P = 0.984(P> 0.05);BMD was analyzed by t test,P = 0.906(P > 0.05);The duration of the disease(months)was analyzed by t test,P = 0.779(P> 0.05),indicating that there was no statistical difference in the basic information between the two groups of patients.The intraoperative blood loss(ml)was analyzed by t test,P = 0.600(P> 0.05),indicating that the intraoperative blood loss was equivalent between the two procedures.The operation time(min)was analyzed by t test,P = 0.007(P <0.05),indicating that the operation time of group B was longer than that of group A.2.The height of lumbar intervertebral space was analyzed by t test.The height of lumbar intervertebral space in group A and group B after 6 months was higher than that before operation(P <0.001),indicating that both surgical methods can restore the lumbar disease segment of the patient.Intervertebral space height.Preoperative comparison of lumbar intervertebral space height,P = 0.345(P> 0.05);postoperative comparison,P = 0.142(P> 0.05);postoperative comparison between groups(P <0.001);postoperative 3 Monthly comparison between groups,P = 0.004(P <0.05);6 months after operation(P <0.001),indicating that group B recovered better than group A after operation.3.The VAS,ODI score and JOA score of patients were analyzed by t test.The preoperative VAS score comparison between groups was P = 0.637(P> 0.05);the preoperative ODI score comparison between groups was P = 0.643(P> 0.05);Comparison between JOA scores before operation,P = 0.075(P> 0.05).Comparison of VAS scores between groups at 1 month after operation,P = 0.004(P <0.05);Comparison between groups at 3 months after operation,P = 0.017(P <0.05);Comparison between groups at 6 months after operation(P <0.001).ODI score comparison between groups at 1 month after operation,P = 0.002(P <0.05);comparison between groups at 3 months after operation,P = 0.016(P <0.05);comparison between groups at 6 months after operation,P = 0.002(P <0.05).Comparison between JOA scores at 1 month after operation(P <0.001);comparison between groups at 3 months after operation(P <0.001);comparison between groups at 6 months after operation(P <0.001),indicating that group B is better than group A The effect is definite.4.PS loosening and extraction were analyzed by t test,1 month after operation between groups,P = 0.045(P <0.05);3 months after operation between groups,P = 0.030(P <0.05);operation between groups After 6 months,P = 0.028(P <0.05),indicating that group B had a lower incidence of postoperative screw loosening than group A.The t-test was used for the fusion rate of bone grafting.There was no bone grafting fusion at 1 month after the two procedures,P = 1.000(P> 0.05);P = 0.018(P <0.05)compared between groups at 3 months after operation;6 months after operation between groups,P = 0.015(P <0.05),indicating that group B has a higher bone graft fusion rate than group A.Conclusion:Injectable cement pedicle screw combined with 360 ° intervertebral fusion group is more effective than double-threaded pedicle screw combined with 360 ° intervertebral fusion group in treating elderly patients with intervertebral instability and lumbar spinal stenosis.Injectable cement pedicle screw combined with 360 ° Intervertebral fusion surgery stabilizes the anterior,middle and posterior columns of the patient’s diseased lumbar spine,and achieves a good clinical treatment effect,which not only enhances the resistance of the screw to pull out,reduces the incidence of postoperative screw loosening,but also improves The fusion rate of intervertebral bone grafting shortens the fusion time. |
