血小板裂解液用于老年腰椎间盘突出症椎体融合术的临床疗效

麻光喜; 张骏; 杨益宇; 王宇

doi:10.16766/j.cnki.issn.1674-4152.002234

血小板裂解液用于老年腰椎间盘突出症椎体融合术的临床疗效

doi: 10.16766/j.cnki.issn.1674-4152.002234

麻光喜^1, ,,
张骏¹,
杨益宇¹,
王宇²

1.
温州市中西医结合医院脊柱外科，浙江温州 325000
2.
温州医科大学附属第一医院脊柱外科，浙江温州 325000

基金项目:

浙江省基础公益研究计划项目 LY21H060007

详细信息

通讯作者:
麻光喜，E-mail: 718880277@qq.com

中图分类号: R681.53 R687.4
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- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2021-06-16
- 网络出版日期: 2022-03-02

Clinical effect of platelet lysate on lumbar interbody fusion in elderly patients with lumbar disc herniation

1.
Department of Spinal Surgery, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的评价血小板裂解液用于老年腰椎间盘突出症椎体融合术后治疗的临床疗效。方法以2018年4月—2020年4月于温州市中西医结合医院就诊并接受治疗的140例微创经椎间孔腰椎椎间融合术老年患者为研究对象，按照随机数字表法分为研究组和对照组，各70例。2组均实施微创经椎间孔腰椎椎间融合术，研究组在此基础上予以血小板裂解液椎间孔隙注射。记录患者手术指标，评价手术前后疼痛反应[视觉模拟评分(VAS)评分]及腰椎功能水平[腰椎Oswestry功能障碍指数(ODI)评分]，比较术后12个月患者腰椎影像学指标，观察术后并发症情况。结果研究组患者手术时间[(182.41±17.28)min]显著长于对照组[(167.86±15.49)min, t=5.219，P＜0.001]，而术中出血量[(218.64±19.53)mL]及住院时间[(6.59±0.71)d]与对照组[(221.57±19.06)mL、(6.41±0.69)d]差异均无统计学意义(t=0.896、1.514，P=0.372、0.132)；研究组术后3、6、9、12个月VAS评分和ODI评分均显著低于对照组(均P＜0.001)；术后12个月，2组腰椎间融合率(98.57% vs. 94.28%)差异无统计学意义(χ²=0.830，P=0.362)，而研究组椎骨融合层数[(4.68±0.52)层]和腰椎间隙高度[(11.62±1.12)mm]均显著高于对照组[(2.91±0.34)层、(10.53±1.04)mm，t=23.873、5.891，均P＜0.001]；2组术后12个月内均未出现并发症。结论血小板裂解液腰椎间孔隙注射可有效缓解老年腰椎间盘突出症椎体融合术后疼痛反应，改善腰椎功能恢复水平，提高腰椎间组织愈合程度和稳定性，且安全性高。
- 血小板裂解液 /
- 腰椎间盘突出症 /
- 椎体融合术 /
- 疼痛反应 /
- 腰椎功能 /
- 愈合程度 /
- 临床疗效
Abstract: Objective To evaluate the clinical efficacy of platelet lysate in the treatment of elderly patients with lumbar disc herniation after vertebral fusion. Methods A total of 140 elderly patients with minimally invasive transforaminal lumbar interbody fusion who were in our hospital from April 2018 to April 2020 were randomly divided into study group and control group, with 70 cases in each group. Both groups were treated with minimally invasive transforaminal lumbar interbody fusion, and the study group was treated with platelet lysate injection. The operation indexes were recorded, and the pain reaction and lumbar function of the two groups were evaluated before and after operation. The differences in lumbar imaging indexes were compared 12 months after operation, and the postoperative complications were observed. Results The operation time of the study group was (182.41±17.28) min, which was significantly longer than that of the control group (167.86±15.49) min, t=5.219, P < 0.001, but no significant differences in blood loss and hospital stay were found between the control group and control group [(218.64±19.53) mL vs. (221.57±19.06) mL and (6.59±0.71) days vs. (6.41±0.69) days; t=0.896, 1.514; P=0.372, 0.132]. The visual analogue scale (VAS) score and ODI score at 3, 6, 9 and 12 months after operation in the study group were significantly lower than those in the control group (all P < 0.001). In addition, no significant difference in the fusion rate was found between the two groups 12 months after operation (98.57% vs. 94.28%, χ²=0.830, P=0.362), whereas the number of fusion layers (4.68±0.52) and the height of lumbar intervertebral space [(11.62±1.12) mm] in the study group were significantly higher than those in the control group [(2.91±0.34) and (10.53±1.04) mm; t=23.873, 5.891, all P < 0.001)]. No complications in the two groups within 12 months after operation. Conclusion Platelet lysate injection into lumbar intervertebral space can relieve the pain reaction after lumbar fusion in elderly patients with lumbar disc herniation and improve the recovery level of lumbar function, the healing degree and stability of lumbar intervertebral tissue. This method has high safety.
- Platelet lysate /
- Lumbar disc herniation /
- Vertebral fusion /
- Pain response /
- Lumbar function /
- Degree of healing /
- Clinical effect

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表 1 2组腰椎间盘突出症患者一般资料比较

组别	例数	年龄(x±s，岁)	体重指数(x±s)	性别(例)		病变腰椎节段(例)			病程(x±s，月)
组别	例数	年龄(x±s，岁)	体重指数(x±s)	男性	女性	L_3~4	L_4~5	L₅~S₁	病程(x±s，月)
对照组	70	64.25±3.28	22.67±1.83	35	35	21	34	15	23.41±2.82
研究组	70	64.79±3.30	22.45±1.95	37	33	23	30	17	23.95±3.09
统计量		0.889^a	0.684^a	0.114^b		0.466^b			1.076^a
P值		0.376	0.495	0.735		0.792			0.284
注：^a为t值，^b为χ²值。

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表 2 2组腰椎间盘突出症患者不同时点VAS评分比较(x±s，分)

组别	例数	术前	术后3个月	术后6个月	术后9个月	术后12个月	F值	P值
对照组	70	6.28±0.59	2.76±0.27^a	2.11±0.24^a	2.15±0.21^a	2.09±0.22^a	17.832	< 0.001
研究组	70	6.34±0.61	2.04±0.21^a	1.63±0.18^a	1.59±0.17^a	1.56±0.18^a	15.961	< 0.001
t值		0.597	16.640	13.407	17.161	15.472
P值		0.552	< 0.001	< 0.001	< 0.001	< 0.001
注：与术前比较，^aP＜0.001。

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表 3 2组腰椎间盘突出症患者不同时间点ODI评分比较(x±s，分)

组别	例数	术前	术后3个月	术后6个月	术后9个月	术后12个月	F值	P值
对照组	70	24.59±2.57	12.76±1.36^a	9.47±1.02^a	8.25±0.96^a	8.16±0.92^a	20.593	＜0.001
研究组	70	24.72±2.61	11.04±1.21^a	8.13±0.94^a	7.09±0.85^a	6.72±0.76^a	17.826	＜0.001
t值		0.294	7.875	8.098	7.453	10.122
P值		0.769	＜0.001	＜0.001	＜0.001	＜0.001
注：与术前比较，^aP＜0.001。

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表 4 2组腰椎间盘突出症患者术后腰椎影像学指标比较

组别	例数	腰椎间融合[例(%)]	椎骨融合层数(x±s，层)	腰椎间隙高度(x±s，mm)
对照组	70	66(94.28)	2.91±0.34	10.53±1.04
研究组	70	69(98.57)	4.68±0.52	11.62±1.12
统计量		0.830^a	23.873^b	5.891^b
P值		0.362	＜0.001	＜0.001
注：^a为χ²值，^b为t值。

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参考文献(16)

[1]	高全有, 韩康, 高浩然, 等. 经皮椎板间内镜治疗腰椎间盘突出症临床疗效观察[J]. 中华全科医学, 2016, 14(7): 1069-1072, 1152. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201607004.htm
[2]	朱旻宇, 李驰, 滕红林, 等. 经皮椎间孔及椎板间隙入路脊柱内镜治疗腰4/5向下游离型椎间盘突出症的临床比较[J]. 中华全科医学, 2018, 16(7): 1116-1120. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201807023.htm
[3]	刘广亚, 许育兵, 张喻, 等. 不同冻融条件下血小板裂解液的制备[J]. 中国输血杂志, 2019, 32(6): 545-548. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201906011.htm
[4]	刘永辉, 赵烨, 赵新炎, 等. 腰椎间盘突出症的微创治疗进展[J]. 中国高新科技, 2020(22): 153-154. https://www.cnki.com.cn/Article/CJFDTOTAL-GXKE202022064.htm
[5]	唐余金. 腰椎间盘突出症的治疗现状与进展[J]. 中国保健营养, 2017, 27(10): 53-54. https://cdmd.cnki.com.cn/Article/CDMD-10183-2004101042.htm
[6]	杜卓姝, 倪冬贝, 张仑. 腰椎间盘突出症患者经改良后路腰椎椎体间融合术治疗疗效及并发症的影响因素[J]. 河北医学, 2021, 27(4): 556-562. doi: 10.3969/j.issn.1006-6233.2021.04.07
[7]	赵华. 经后路椎间盘摘除植骨融合内固定术治疗腰椎间盘突出症患者的临床研究[J]. 中国社区医师, 2018, 34(34): 85, 87. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYS201834053.htm
[8]	闫慧博, 金大地, 黎庆初, 等. 前路腰椎融合术治疗复发性腰椎间盘突出症的临床效果和安全性分析[J]. 中国临床解剖学杂志, 2020, 38(5): 600-604. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLJZ202005023.htm
[9]	王伟, 李罡, 单周通, 等. 经皮椎间孔镜治疗腰椎间盘突出症的最新进展[J]. 牡丹江医学院学报, 2018, 39(2): 89-91, 13. https://www.cnki.com.cn/Article/CJFDTOTAL-MDJB201802035.htm
[10]	陈海, 谌洪宇, 刘勇, 等. 经皮椎间孔镜下微创技术治疗老年腰椎间盘突出症术后恢复的影响因素[J]. 中国老年学杂志, 2021, 41(7): 1424-1427. doi: 10.3969/j.issn.1005-9202.2021.07.024
[11]	鞠昌军, 姜红江, 高广凌, 等. 体外人工膝支具辅助血小板裂解液治疗膝关节骨性关节炎的临床疗效分析[J]. 中华老年骨科与康复电子杂志, 2018, 4(4): 224-230. doi: 10.3877/cma.j.issn.2096-0263.2018.04.007
[12]	胡介宇, 肖国强, 王茜, 等. 血小板裂解液代替动物血清进行间充质干细胞体外扩增的研究进展[J]. 中国综合临床, 2018, 34(3): 281-284. doi: 10.3760/cma.j.issn.1008-6315.2018.03.020
[13]	谢贤哲, 徐燕, 何家林, 等. 人血小板裂解液在人牙髓间充质细胞体外增殖与分化中的应用[J]. 安徽医科大学学报, 2019, 54(10): 1551-1556.
[14]	徐杨, 林飞跃, 尹晓明. 混合血小板裂解液对人骨髓间充质干细胞原代培养、增殖和成骨分化的影响[J]. 中国当代医药, 2019, 26(18): 13-18. doi: 10.3969/j.issn.1674-4721.2019.18.005
[15]	刘广亚, 许育兵, 张喻, 等. 富血小板血浆与血小板裂解液治疗跟腱炎的比较研究[J]. 中国中医骨伤科杂志, 2019, 27(10): 22-25. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZG201910007.htm
[16]	侯燕, 秦立武, 鞠昌军, 等. 血小板裂解液关节腔注射治疗膝骨性关节炎的临床观察[J]. 中国中医骨伤科杂志, 2017, 25(11): 29-32. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZG201711007.htm