骨水泥加强长节段钉棒置入治疗伴骨质疏松症的退变性脊柱侧弯22例  

Long segment pedicle screw/rod internal fixation system insertion by augmentation and restoration with bone cement for degenerative scoliosis accompanied by osteoporosis in 22 cases

作　　者：喻林[1] 石志才[1] 白玉树[1] 章筛林[1] 

机构地区：[1]解放军第二军医大学附属长海医院骨科,上海市200433

出　　处：《中国组织工程研究与临床康复》2008年第35期6963-6967,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：选取2003-03/2008-05解放军第二军医大学附属长海医院收治的伴骨质疏松症的退变性脊柱侧弯患者22例,女18例,男4例,平均年龄67.3岁,根据患者脊柱畸形程度、神经症状等,将患者分为两组:冠状面严重畸形(cobb’s角>20°)或合并椎体旋转半脱位以及合并椎体病理性骨折的患者14例为第1组,采取拟减压节段全椎板切除,部分切除小关节突,松解神经根,以充分减压,采用骨水泥强化的椎弓根钉棒系统进行矫形;冠状面畸形程度较轻(cobb’s角<20°),无明显椎体旋转脱位或病理性骨折,神经症状较轻,或X射线片显示椎体间部分有骨桥形成及腰椎不稳表现较轻的患者8例为第2组,采取拟减压节段椎板蝶形减压,切除增生黄韧带以扩大椎管,采用骨水泥强化的椎弓根钉棒系统进行有限矫形及固定,同时行后外侧融合。所有病例均进行36～48个月随访(平均40个月),未出现断钉、断棒,椎弓根钉拔出、松动、融合节段假关节形成以及切口感染等严重并发症。两组患者术后腰椎矢状面前凸角均高于术前(P<0.05),冠状面cobb’s角均低于术前(P<0.05),疼痛VAS评分均低于术前(P<0.05),神经症状JOA29分评分明显改善。Twenty patients, 18 females and 4 males with average age of 37.3 years, with degenerative scoliosis accomplished by osteoporosis were selected from Shanghai Hospital of Second Military Medical University of Chinese PLA between March 2003 and May 2008. According to the degree of spinal deformity and neural symptoms etc., the patients were divided into two groups： severe coronal plane deformity （Cobb＇s angle 〉 20°） or vertebral semiluxation and vertebral pathological fracture group （n=14）, which was treated with full laminectomy and limited correction with pedicle screw/rod internal fixation system by augmentation and restoration with bone cement in the screw tract; mild coronal plane deformity （Cobb＇s angle 〈 20°） with no obvious vertebral semiluxation or vertebral pathological fracture or bone bridge formation and mild lumbar instability （n=8）, which was treated with butterfly laminectomy, posterior long segment pedicle screw/rod internal fixation system by augmentation and restoration with bone cement in the screw tract and posterolateral spinal fusion. All cases were followed up for 40 months （range, 36-48 months）. No screw breakage, rod breakage, screw extraction, loosening, pseudoarticulation formation, or incision infection was found. The postoperative lordosis angle in sagittal plane was significantly higher than preoperative angle （P 〈 0.05）, and Cobb＇s angle in coronal plane was significantly lower than preoperative angle （P 〈 0.05）. In addition, the postoperative VAS score was remarkably lower than preoperative score （P 〈 0.05）. The JOA29 score were improved significantly.

关 键 词：骨质疏松症 退变性脊柱侧弯 内固定器 骨水泥 外科矫形 外科减压术 后外侧融合术 

分 类 号：R318[医药卫生—生物医学工程]