摘要
目的探讨膨胀式椎弓根螺钉结合骨水泥强化钉道在治疗严重骨质疏松性脊柱内固定手术中的早期疗效。方法自2006年10月至2008年10月对20例需行内固定治疗同时合并严重骨质疏松的腰椎疾病患者采用膨胀式椎弓根螺钉结合骨水泥强化钉道进行脊柱后路稳定手术，其中男9例，女11例；年龄43～73岁，平均59岁。分别于术后1周、3个月、6个月、12个月及24个月摄动力位x线片及CT扫描，了解螺钉稳定性、骨水泥分布及脊柱融合情况。术前及术后3个月时应用日本矫形外科协会（JOA）下腰痛评分及视觉模拟评分（VAS）评价疗效。结果本组共置入膨胀式椎弓根螺钉168枚。所有患者术后获12～38个月（平均26个月）随访。术前及术后3个月JOA评分平均分别为（11．4±2．6）分和（24．9±1．6）分，差异有统计学意义（t=19．776，P=0．000）；术前及术后3个月VAS评分分别为（7．0±1．4）分和（2．1±1．3）分，差异有统计学意义（t=11．470，P=0．000）。螺钉及骨水泥在椎体内位置稳定，周围骨小梁致密，未见明显透光带，无内固定松动移位迹象；后外侧融合节段植骨愈合良好，椎体间或椎板、关节突及棘突旁有连续性骨小梁形成，连接上下椎体。临床症状明显缓解，无早期及晚期感染等并发症发生，无临床复发。结论对于合并严重骨质疏松的脊柱后路内固定手术，膨胀式椎弓根螺钉结合骨水泥强化钉道的方法能够极大地提高螺钉固定的稳定性。
Objective To evaluate the short-term clinical and radiographic results of a novel expandable pedicle screw instrumentation combined with cement augmentation in surgery for the severely osteoporotic spine. Methods From October 2006 to October 2008, 20 patients suffering from spinal diseases and severe osteoporosis were included in this clinical triM. They were 9 men and 11 women, with an average age of 59 years （range, 43 to 73 years）. The preoperative bone mineral density （BMD） scan revealed a mean BMD decrease of 3.2 ±0.4. At one week, 3 months, 6 months and 12 months after surgery, plain radiography and three-dimensional CT scan were conducted to evaluate the spinal fusion and effectiveness of the instrumentation combined with cement augmentation, as well as the cement leakage. Functions were evaluated pre-operatively and 3 months post-operatively with Japanese Orthopaedic Association （JOA） and visual analog scores （VAS）. Results Altogether 168 expandable pedicle screws were implanted. The mean follow-up period was 26 months （range, 12 to 38 months）. The mean JOA and VAS improved respectively from 11.4 ± 2. 6 and 7.0 ± 1.4 before operation to 24. 9 ± 1.6 and 2. 1 ± 1.3 at 3 months after operation （ P 〈 0. 05 ） . The three-dimensional CT scan observed cement leakage anteriolaterally to the fractured vertebral body （2 cases） and to the adjacent disc （3 cases） without clinical sequelae. No cement leaked into the spinal canal. The spatial distribution of cement was satisfactory. There were no instances of loosening or pullout of the expandable pedicle screws. The screw-cement interface and cement-bone interface were excellent radiologically. Posterolateral radiologic fusion and bone healing around screws were achieved within 6 to 12 months after operation. Conclusion In surgery for severely osteoporotic spine, excellent bone-screw interface and fixation strength can be achieved by expandable pedicle screw instrumentation combined with cement augmentation, a feasible novel fixation ahemative for orthopaedic surgeons.
出处
《中华创伤骨科杂志》
CAS
CSCD
2011年第2期114-118,共5页
Chinese Journal of Orthopaedic Trauma
关键词
脊柱
骨质疏松
内固定器
Spine
Osteoporosis
Internal fixators
