新型可注射骨水泥椎弓根螺钉与骨水泥钉道强化在治疗腰椎滑脱伴骨质疏松中的比较研究  

Comparative study of bone cement injectable canulated pedicle screw and conventional screw path-augmentation with bone cement in treatment of lumbar spondylolisthesis with osteoporosis

作　　者：代飞[1] 刘瑶瑶[2] 孙东[1] 徐美涛[1] 许建中[1] 

机构地区：[1]第三军医大学西南医院骨科,重庆400038 [2]第三军医大学大坪医院脊柱外科

出　　处：《脊柱外科杂志》2014年第5期257-261,共5页Journal of Spinal Surgery

基　　金：重庆市科技攻关项目(CSTC2012gg-yyjs10015)

摘　　要：目的比较新型可注射骨水泥椎弓根螺钉（bone cement injectable canulated pedicle screw,CICPS）和传统骨水泥钉道强化方法应用于治疗腰椎滑脱伴骨质疏松患者的临床疗效。方法 2011年7月~2013年11月序贯纳入腰椎滑脱伴骨质疏松患者（T〈-2.5）43例,随机分为2组,A组20例采用CICPS行后路滑脱复位植骨融合内固定术。B组23例采用传统骨水泥钉道强化内固定术。比较2组手术时间、出血量、住院时间。采用疼痛视觉模拟量表（visual analogue scale,VAS）评分,Oswestry功能障碍指数（Oswestry disability index,ODI）评价患者术后疼痛和功能恢复。术前及术后1、3、6、12个月及术后每年行X线和CT检查评估椎间隙高度丢失、内固定失败率和椎间植骨融合率。结果 43例患者均得到随访,随访时间为6~33个月,平均16.5个月。A组手术时间、出血量、住院时间显著低于B组（P〈0.05）。A组和B组植骨融合率分别为94.6%、90.2%,2组比较差异无统计学意义（P〉0.05）。B组发生内固定松动、螺钉拔出3例,A组未发生此类情况。A组椎间隙高度丢失（2.3±1.2）mm,B组椎间隙高度丢失（3.6±2.2）mm,2组比较差异有统计学意义（P〈0.05）。根据VAS评分和ODI,2组患者术后疼痛与功能均得到改善,A组效果优于B组（P〈0.05）。结论 CICPS强化内固定稳定性是一种具有较好安全性和有效性的新方法。Objective To compare the clinical effect of bone cement injectable canulated pedicle screw （CICPS） and conven-tional screw path-augmentation with bone cement in the treatment of lumbar spondylolisthesis with osteoporosis patients.Methods From July 2011 to November 2013, sequential 43 patients with osteoporosis （T≤-2.5） and lumbar spondylolisthesis were randomly divided into 2 groups.Group A of 20 cases were treated with CICPS and group B of 23 cases were treated with conventional screw path-augmentation in internal fixation.Operation time, amount of bleeding and hospitalization time was used to evaluate the clinical characteristics.visual analogue scale（VAS）score and Oswestry disability index（ODI）was used to evaluate function recovery of post-operative pain and function.The height of intervertebral space, failure rate of internal fixation and bone fusion rate were analyzed by X-ray films and CT examination postoperative 1, 3, 6, 12 months and per year.Results All 43 cases were followed up （6-33 months, average 16.5 months）.Operation time, amount of bleeding and the time of hospitalization of group A was significantly low-er than that in group B （P〈0.05）.The fusion rate of group A and group B were 94.6%and 90.2%, respectively.There was no significant difference between 2 groups （P〉0.05）.Three cases of group B had screw loosening or pullout, but that did not happen in group A.The loss of intervertebral height was（2.3 ±1.2 ）mm in group A compared with （3.6 ±2.2） mm in group B （P〈0.05）.According to VAS score and ODI, pain and function in both groups were improved, but the effect of group A was better than that of group B （P〈0.05）.Conclusion Bone cement-augmentation CICPS may be a safety and effectiveness method in treatment of lumbar spondylolisthesis with osteoporosis .

关 键 词：腰椎 脊柱前移 骨质疏松 骨代用品 内固定器 老年人 

分 类 号：R681.533[医药卫生—骨科学]