3D计算机导航下经椎弓根骨水泥增强螺钉的应用  

Polymethylmethacrylate-augmented thoracolumbar pedicle screw fixation guided by the three-dimensionalnavigation in osteoporotic patients

作　　者：袁强[1] 张贵林[1] 吴静晔[1] 行勇刚[1] 何达[1] 孙宇庆[1] 田伟[1] 

机构地区：[1]北京积水潭医院脊柱外科,100035

出　　处：《中华创伤骨科杂志》2014年第3期199-203,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的评价在3D计算机导航下经椎弓根骨水泥增强胸腰椎椎弓根螺钉内固定术的安令性和仃效性、方法2010年1月至2012年1月27例不同脊柱疾患伴骨质疏松的患者接受了3D计算机导航F经惟弓撤骨水泥增强螺钉内固定术，男3例，女24例；年龄5l-92岁，平均70．1岁、术中及术后评仙骨水泥渗漏情况，术后通过影像学检查评估螺钉松动及骨折愈合情况，并埘患者术前和术后1年日本骨科阱会（JOA）评分进行比较、，结果27例患者共置人骨水泥增强螺钉149枚。l例患行死亡，26例忠肯随访达12个川以上。无椎弓根皮质破裂及椎弓根刷同骨水泥渗漏，无出现可疑肺栓塞引起的呼吸I木l难和手术引起的神经损伤。术后末出现相关症状加重、功能状态下降等不良效果。术后JOA评分[（25．1±2．3）分]较术前[（18．2±2．6）分]明硅提高，差异有统计学意义（t=16．996，P：0．000），平均改善率为39．6％。所有患者均未出现内固定物松动和移位，20例（76．9％）患者随访12个月时骨折愈合。结论3D计算机导航下经椎弓根骨水泥增强螺钉内固定术具有良好的安全性和有效性，任临床评估及影像。簟表现上均得到良好效果。Objective To evaluate the safety anti efficacy of pnlymethyhnethacrylate （PMMA）-augmented th（thoracolumbar pediele screw fixation guided by three-dimensional （3D） navigation in the osteo- porotic patients. Methods From January＂ 2010 to January 2012, 27 osteoporotic patients with a variety of spinal disorders underwent PMMA-augmented thoracolumlmr pedicle screw fixation guided by 31） navigation. They were 3 men and 24 women, aged from 51 to 92 years （average, 70. 1 years）. Their osteoporosis was all serious. PMMA leakage was evaluated intraoperatively and postoperatively. Screw loosening and bone fusion were evaluated radingraphically after operation. The Japanese Orthopaedic Assoeiation （JOA） scores of the patients were compared between preoperation and one year postoperation. Results Altogether 149 pedicle screws were implanted in the 27 patients. One patient died of postoperative pneumonia and the rest 26 patients were fnllowed up for more than 12 months. No pedicle cortex breach or cement leakage surrounding the pediele cnrlex was observed. None of the patients complained of dyspnoea showing evidence of pulmonary embolism or iatrngenic neural injury. No obviot, s deterioration of related symptnms or functions was observed ＇after opera- tim1. The pre-operative JOA score （18.2 ＋ 2.6 points） was significantly increased （25. 1 ＋ 2.3 points） postoperalion （ t = 16. 996, P = 0. 000）, with a mean therapeutic improvement rate of 39.6%. None of the patients showed loosening or displaeement of the implants. Lateral X-ray fihns showed bone fusion in 20 pa-tients （76.9%） at the 12-month fnllow-up Conclusion PMMA-augmented thoracolumbar pediele screw fixatiml guided by 31） navigation is safe and effective for osteoporotie patients with a variety of spinal disorders, leading to fawu＇able outcomes both clinically and radiologically.

关 键 词：外科技术 计算机辅助 骨质疏松 椎体成形术 

分 类 号：R687.3[医药卫生—骨科学]