| Objective:To explore the quality evaluation of posterior lumbar interbody fusion(PLIF)in the treatment of elderly lumbar degenerative diseases,analysis of related factors,and observation of the clinical efficacy of "nourishing liver and kidney method",observe the differences in the quality of clinical fusion,summarize and refine,and provide reference for future clinical diagnosis and treatment through systematic and comprehensive research.Methods:1.According to the exclusion and inclusion criteria,the elderly patients with lumbar degenerative diseases who underwent posterior lumbar interbody fusion(PLIF)in the Department of Orthopedics,Affiliated Hospital of Shandong University of Traditional Chinese Medicine from October 2020 to October 2021 were collected and selected.(1)Four influencing factors,including total laminectomy and hemilaminectomy,autogenous bone and allogeneic bone,normal bone mass and osteoporosis,single segment and double segment,were used as the research objects.The patients were divided into four groups: single segment + total laminectomy+ autogenous bone + normal bone mass(group A),single segment +hemilaminectomy + autogenous bone + normal bone mass(group B),single segment + total laminectomy + autogenous bone + allogeneic bone + normal bone mass(group C),single segment + total laminectomy + autogenous bone+ osteoporosis(group D),double segment + total laminectomy + autogenous bone + normal bone mass(group D).Group E),30 cases in each group,a total of 150 cases were collected.The data of Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)were collected before operation,3months,6 months and 12 months after operation.Mayer’s CT fusion evaluation index was used to record the lumbar interbody fusion rate at 3months,6 months,and 12 months after operation.The above data were statistically processed to analyze the influence of four factors on postoperative clinical efficacy and fusion rate at different follow-up time.(2)According to the fusion and non-fusion at the last follow-up,150 cases were divided into two groups: fusion group and non-fusion group.The basic data of all cases were collected,including age and gender.The clinical data included bone mineral density,operation method,operation time,blood loss,and bone graft materials.The above data were statistically processed and comprehensively compared to analyze the related factors affecting lumbar interbody fusion after PLIF treatment of lumbar degenerative diseases in elderly patients.2.A total of 60 patients with single segment + total laminectomy +autologous bone + osteoporosis were collected and randomly divided into two groups,with 30 cases in each group.One group was the control group,treated with caltrate calcium carbonate D3 after operation,and the other group was the treatment group,treated with "nourishment liver and kidney method" on the basis of the control group.The VAS score,ODI score and lumbar intervertebral fusion rate of the two groups were recorded before operation,3 months,6 months and 12 months after operation,and the clinical efficacy of "nourishing the liver and kidney method" in the treatment of PLIF in OP patients was statistically evaluated.Results:1.(1)General data: there was no significant difference in general data among the five groups(P > 0.05).(2)Intraoperative evaluation: the operation time and blood loss in group A were greater than those in group B,and the difference was statistically significant(P < 0.01).There was no significant difference in operation time and blood loss among the three groups(P > 0.05).The operation time and blood loss in group A were less than those in group E,and the differences were statistically significant(P < 0.01).(3)Score evaluation:(1)Comparison between groups: there was no significant difference in VAS score and ODI score between the five groups before operation,3 months,6 months and 12 months after operation(P > 0.05).(2)Intra-group comparison: the VAS and ODI scores of the five groups at 3 months after operation were significantly better than those before operation,the VAS and ODI scores at 6 months after operation were significantly better than those at 3 months after operation,and the ODI scores at 12 months after operation were significantly better than those at 6 months after operation(P < 0.05).There was no significant difference in VAS score between 12 months after operation and 6 months after operation(P > 0.05).(4)Comparison of fusion rate:(1)There was no significant difference in fusion rate between group A and group B at 3 months,6 months and 12 months after operation(P > 0.05).(2)Group A and C: the fusion rate of group A was higher than that of group C at 3 months and 6 months after operation,and the difference was statistically significant(P <0.05).There was no significant difference in fusion rate at 12 months after operation(P > 0.05).(3)Group A and group D: the patients in group A at 3 months,6 months and 12 months after operation were significantly higher than those in group D(P < 0.05).(4)Group A and group E: the fusion rate of group A at 3 months and 6 months after operation was higher than that of group E,and the difference was statistically significant(P <0.05).There was no significant difference in fusion rate at 12 months after operation(P > 0.05).(5)Logistic regression analysis showed that osteoporosis(P=0.010,OR=4.312,95%CI=1.410-13.188)and operation time(P=0.038,OR=0.976,95%CI=0.954-0.999)were risk factors for long-term interbody fusion after PLIF.2.(1)General data: there was no significant difference in general data between the treatment group and the control group(P > 0.05).(2)There was no significant difference in VAS score and ODI score between the two groups before operation(P > 0.05).The VAS score and ODI score of the treatment group were better than those of the control group at 3 months,6 months and 12 months after operation,with statistically significant differences(P < 0.05).(3)Comparison of fusion rate: the fusion rate of the treatment group at 3 months,6 months and 12 months after operation was higher than that of the control group,and the difference was statistically significant(P < 0.05).(4)TCM syndrome efficacy evaluation:the overall TCM syndrome efficacy of the treatment group was better than that of the control group,the difference was statistically significant(P< 0.05).Conclusion:1.In the treatment of lumbar degenerative diseases with PLIF,total laminectomy and hemilaminectomy have no significant effect on the shortterm and long-term treatment effect,while allogeneic bone,osteoporosis,double segment have different degrees of influence on the postoperative treatment effect.2.Osteoporosis and operation time are the risk factors of long-term interbody fusion after PLIF.The interbody fusion rate in patients with normal bone mass was 4.312 times higher than that in patients with osteoporosis.There is a negative correlation between the operation time and the postoperative interbody fusion rate,that is,the longer the operation time,the higher the possibility of postoperative interbody nonfusion.3.For patients with PLIF combined with osteoporosis,"nourishing the liver and kidney method" can effectively improve the postoperative lumbar fusion rate.At the same time,"nourishing the liver and kidney method" can effectively reduce the adverse effect of osteoporosis on interbody fusion. |
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