骨水泥加强椎弓根螺钉内固定治疗伴骨质疏松症的腰椎退行性病变

摘要

Objective To explore the clinical efficacy of the use of polymethylmethacrylate (PMMA)-augmented transpedicular screw fixation for the treatment of lumbar degenerative disease accompanied with osteoporosis.Methods Thirty-eight patients of lumbar degenerative disease accompanied with osteoporosis from Jun 2004 to Jan 2009 were selected with intact follow-up data.They were 16 males and 22 females with average age of 62.5 years, including lumbar degenerative stenosis 16 cases, lumbar intervertebral disc herniation combined with segmental instability 12 cases, lumbar degenerative spondylolisthesis 6 cases, and lumbar degenerative scoliosis 4 cases.The patients were treated with lumbar canal decompression, or fusion,or transpedicular screw fixation by augmentation with PMMA in the screw tract, according to their clinical feature and imaging results.The postoperative outcomes were evaluated using Oswestry Disability Index (ODI) scale, visual analog scale (VAS), and radiological findings.Results All cases were followed up for 18-48months (36.5 months in average).Low back pain and leg pain were released apparently.There were no loosens and dislocations of the screw postoperatively according to X-ray scan.No bright lines appeared around the screws.Upon the last follow-up time, the VAS for low back pain decreased from 7.46 ± 2.24 preoperatively to 3.15 ± 1.47 postoperatively ( P ＜ 0.01 ).The VAS for leg pain decreased from 7.24 ±2.32.preoperatively to 2.11 ±0.84 postoperatively (P ＜0.01 ).ODI score decreased from 43.15 ±5.72 preoperatively to 15.41 ± 6.42 postoperatively ( P ＜ 0.01 ).The intraoperative and postoperative complications occurred in 16 cases.The complications did not cause any delayed damage.Conclusion For patients suffering from lumbar degenerative disease accompanied with osteoporosis, PMMA in the screw tract was helpful for increasing the stabilization of transpedicular screw and preventing from loosen and dislocation of the screws, therefore beneficial for improvement and maintenance of clinical efficacy.%目的 探讨应用聚甲基丙烯酸甲酯(PMMA)骨水泥行椎体加强后椎弓根螺钉内固定治疗伴骨质疏松症的腰椎退行性病变的临床效果.方法 选取本科2004年6月～2009年1月收治的随访资料完整的伴骨质疏松症的腰椎退行性病变患者38例,男16例,女22例;年龄为52～76岁,平均62.5岁.其中腰椎管狭窄症16例,腰椎间盘突出症并节段不稳12例,退行性腰椎滑脱症6例,腰椎退行性侧凸4例.根据患者临床表现及影像学资料确定减压、融合节段和方法,采用PMMA骨水泥强化的椎弓根钉棒系统进行内固定、矫形.采用ODI评分、腰痛及腿痛VAS评分、术后影像学资料评定治疗效果.结果 本组病例术后随访时间18～48个月,平均36.5个月.患者腰痛及下肢疼痛症状均明显缓解,复查X线片均未发现椎弓根螺钉的松动或脱出,椎弓根螺钉周围未发现有透亮线出现.末次随访时,腰痛VAS评分由术前的7.46±2.24减至3.15±1.47(P<0.01),腿痛VAS评分由术前的7.24±2.32减至2.11±0.84(P<0.01).ODI评分由术前的43.15±5.72下降至15.41±16.42(P<0.01).出现术中、术后并发症16例次,未造成机体残余损害.结论 对于伴骨质疏松症的腰椎退行性病变患者,应用PMMA行椎体加强椎弓根螺钉固定,能增强螺钉的稳定性,防止螺钉的松动或脱出,有助于临床疗效的改善和保持.