骨水泥强化椎体提高椎弓根螺钉置入后的稳定性  

Bone cement for augmentation of the vertebral body increases the stability of pedicle screw

作　　者：吴云刚[1] 石志才[1] 张晔[1] 毛宁方[1] 喻林[1] 管俊杰[1] 

机构地区：[1]解放军第二军医大学长海医院骨科,上海市200433

出　　处：《中国组织工程研究与临床康复》2010年第42期7951-7954,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:胸腰椎退变性疾病合并骨质疏松症时,临床治疗棘手。采用椎体骨水泥灌注可增强椎弓根螺钉及脊柱稳定性。目的:观察椎体骨水泥灌注提高椎弓根螺钉置入后稳定性在治疗骨质疏松症合并腰椎疾病的临床疗效,并分析骨水泥灌注技术参数及固定节段选择对结果的影响。方法:39例骨质疏松症合并腰椎疾病患者采用骨水泥灌注强化椎体加椎弓根螺钉固定、椎板减压神经根松解及后外侧植骨融合治疗。术前及术后6,12,24,36个月随访进行JOA评分,计算手术改善率;行X射线片及MRI检查,并观察有无并发症发生。结果与结论:置入螺钉过程中未发生因骨水泥渗漏、放热效应及毒性反应引起并发症;手术时间90～180min,置入失血量600～1000mL,单椎体操作时间8～12min;单椎体骨水泥用量3.5～5.0mL。置入前JOA评分平均11分,置入后1年随访平均为23分,改善率66.7%;末次随访平均25分,改善率77.8%。1例置入后2年发生固定节段上方椎体压缩性骨折。随访期间未出现螺钉松动、断裂和脱出;无断棒现象发生。结果提示,椎体骨水泥灌注提高椎弓根螺钉置入后的稳定性,是治疗骨质疏松症合并腰椎疾病是一种可靠的方法。BACKGROUND： The treatment of severe osteoporosis with lumbar degenerative diseases is difficult, vertebral body perfusion of bone cement could increase the stability of pedicle screw and spine. OBJECTIVE： To explore the clinical effect of the bone cement augmentation of vertebral body to increase stability of pedical screw for the treatment of severe osteoporosis with lumbar diseases, and to analyze the technical parameters of bone cement infusion and the influence of the fixed segments. METHODS： A total of 39 patients who suffered from osteoporosis with lumbar diseases and underwent posterior decompression and laminectomy were reviewed retrospectively. In surgical procedures the augmentation of vertebral body strength using bone cement and pedicle screw fixation were used. The JOA scores were assessed at pre-and post-operation （6, 12, 24, 36 months）, and effective rate of the operation was calculated. The X-ray examination and MRI examination were performed to evaluate the complications. RESULTS AND CONCLUSION： There were no complications such as bone cement leakage, heat emission and toxicity occurring during operation. The operating time was 90-180 minutes with the intraoperative blood loss of 600-1 000 mL. The operating time for one vertebral body was 8-12 minutes with the bone cement volume of 3.5-5.0 mL. The average JOA scores were 11 points pre-operation, 23 points at post-operative one year and 25 points at the final follow-up. The effective rate was 66.7% at one year and 77.8% at final follow-up. During follow-ups, 1 case had suffered from adjacent vertebral compressive fracture, there was no pedicle screws loosen, broken or pulled out. The technology of augmenting vertebral body strength using bone cement and pedicle screw fixation is a reliable method for treatment of osteoporosis with degenerative lumbar diseases.

关 键 词：骨质疏松症 腰椎 骨水泥 椎体成形 椎弓根螺钉 

分 类 号：R318[医药卫生—生物医学工程]