骨水泥强化椎弓根螺钉在腰椎滑脱伴骨质疏松椎体中的临床应用  

Clinical application of augmented pedicle screw fixation with bone cement in lumber spondylolisthesis accompanied with osteoporosis

作　　者：李鹏[1] 毛克亚[1] 王岩[1] 肖嵩华[1] 张永刚[1] 张西峰[1] 张雪松[1] 程自申[1] 毛克政[1] 

机构地区：[1]中国人民解放军总医院骨科,100853

出　　处：《中国骨质疏松杂志》2011年第11期961-963,960,共4页Chinese Journal of Osteoporosis

基　　金：国家自然科学基金(50830102);国家863计划(2009AA02Z405)

摘　　要：目的探讨骨水泥强化椎弓根螺钉在腰椎滑脱伴骨质疏松患者的手术方法和疗效。方法 2008年7月至2010年11月年期间收治腰椎滑脱伴骨质疏松患者12例,平均68岁。骨质疏松按Jikei分级Ⅱ级4例,Ⅲ级8例。所有患者行经椎弓根螺钉内固定,术中采用骨水泥强化提高螺钉稳定性,植入椎弓根螺钉共26枚,观察椎弓根螺钉术中及术后的稳定性。结果患者未发生手术并发症,腰腿痛症状改善明显,术后VAS评分较术前比较改善明显。12例患者均获得随访,随访时间8-16个月,平均14个月。12例均获得骨性融合,X线片显示内固定无松动、断裂或脱落,螺钉周围未见透亮线出现。结论经椎弓根骨水泥强化椎弓根螺钉,固化椎体的同时增加了椎弓根螺钉界面把持力,能够满足腰椎滑脱伴骨质疏松患者脊椎后路固定手术对力学稳定的要求。Objective To explore the surgical method and efficacy of augmented pedicle screw fixation with bone cement for the treatment of lumber spondylolisthesis accompanied with osteoporosis. Methods Twelve lumber spondylolisthesis patients accompanied with osteoporosis were collected and treated from July 2008 to November 2010, with an average age of 68 years old. According to Jikei scale for osteoporosis, 4 patients were in stage Ⅱ and 8 patients were in stage Ⅲ All patients were treated with internal fixations of pedicle screws and the stabilities of screws were augmented by bone cement augment during operations. Twenty-six pediele screws were instrumented in this study. The stabilities of pedicle screws during and after the operation were observed. Results There were no operative complications. The symptoms of waist and leg pain were clearly alleviated. The VAS scores after operations were clearly ameliorated compared to those before the operation. All 12 patients were followed up for 8-16 months, with a mean of 14 months. All 12 patients achieved bone unions. The X-ray showed no fixation loose, no broken or drop, and no bright lines around the screws. Conclusion The techniques of augmented pedicle screw fixation with bone cement can solidify the vertebral bodies and increase the holding force of pediclc screw at the same time. It can satisfy the request of mechanical stability of posterior spinal fixation for the treatment of lumber spondylolisthesis patients accompanied with osteoporosis.

关 键 词：骨质疏松 腰椎滑脱 椎弓根螺钉 骨水泥 椎体强化 

分 类 号：R682.3[医药卫生—骨科学]