骨水泥强化椎弓根螺钉手术相关并发症及分析  

The surgery related complications analysis of cement-augmented pedicle screws

作　　者：苏楠[1] 费琦[1] 王炳强[1] 李东[1] 李锦军[1] 孟海[1] 杨雍[1] 

机构地区：[1]首都医科大学附属北京友谊医院骨科,北京100050

出　　处：《临床和实验医学杂志》2015年第12期1012-1016,共5页Journal of Clinical and Experimental Medicine

基　　金：首都医科大学基础-临床科研合作课题(13JL37);2013北京市科学技术委员会"首都市民健康项目培育"(编号:Z131100006813040)

摘　　要：目的探讨骨水泥强化椎弓根螺钉手术相关并发症发生率,分析其发生原因并提出可能的避免对策。方法回顾性分析2014年2月至2015年2月进行骨水泥强化椎弓根钉植入的手术病例,记录患者一般临床资料并通过X线测量螺钉植入深度(螺钉尖端与椎体后缘距离)与椎体矢状径比值,收集患者围手术期并发症及骨水泥相关并发症发生情况,通过Logistic回归分析并发症发生的影响因素。结果 13例手术共75枚骨水泥强化椎弓根螺钉,平均年龄66.85岁,平均体重指数22.65 kg/m2;平均手术时间152.03 min,平均出血量450.00 ml;股骨颈骨密度T值-2.0至-3.6。75枚椎弓根螺钉中9枚骨水泥渗漏(6枚渗漏入椎体周围,3枚渗入血管),渗漏发生率12.00%。椎体周围未渗漏组螺钉拧入深度与椎体椎体矢状径比值平均0.81±0.09,渗漏组比值平均0.62±0.07,两者有显著性差异(P<0.05)。多因素非条件Logistic回归显示患者BMI、螺钉拧入椎体深度是椎体周围骨水泥渗漏的独立危险因素(P<0.05),与患者年龄、性别、骨密度结果、手术节段等无关。所有患者均无神经系统损害加重表现。无肺栓塞、猝死等恶性不良事件发生。1例患者出现邻近节段再骨折。短期随访内固定系统无松动、断裂表现。结论骨质疏松患者脊柱后路减压术中行骨水泥强化椎弓根钉内固定近期可以获得可靠的稳定性,手术相关并发症较少,但需要密切关注术中螺钉拧入深度和骨水泥渗漏的发生。Objective To explore and analyze the surgery related complications of PMMA cement-augmented pedicle screws. Methods 13 patients underwent posterior spinal decompression and PMMA cement-augmented pedicle screws instrumentation were retrospectively ana-lyzed. The clinical data of patients including the age,sex,BMI,BMD,operative time and bleeding,the depth of the screws in the vertebral and the cement leakage of each screw were recorded. We analyzed the risk factors leading to cement leakage by Logistic regression. Results 13 osteo-porotic patients（a total of 75 cannulated pedicle screws with cement augmentation,with mean age of 66. 85 years）were enrolled in this study. The range of BMD T-score in femoral neck site of all patients was from -2. 0 to -3. 6. The cement leakage rate was 12. 00%（9/75）. The ra-tio of the depth of the screws in the vertebral and the vertebral sagittal diameter was 0. 81 in the group without intraoperative cement leakage,while 0. 62 in the group with cement leakage. The depth of the screws in the vertebral and BMI were risk factors of cement leakage. One patient had a postoperative adjacent vertebral fracture. Conclusion Posterior spinal decompression using PMMA cement-augmented pedicle screws instrumen-tations for osteoporotic patients can get satisfied fixed effects with good safety. However,we should pay close attention to the depth of the screws in the vertebral and the occurrence of cement leakage during surgery.

关 键 词：椎弓根螺钉手术 骨水泥 并发症 

分 类 号：R687.3[医药卫生—骨科学]