PMMA增强的多孔中空椎弓根螺钉加单枚椎间融合器治疗腰椎滑脱症  

PMMA reinforced porous hollow pedicle screw plus single pieces interbody fusion for lumbar spondylolisthesis

作　　者：刘勇[1] 樊勇 蒋从斌[1] 吴子祥 

机构地区：[1]武警湖北省总队医院骨一科,湖北武汉430061 [2]西京医院骨四科,陕西西安710000

出　　处：《生物骨科材料与临床研究》2015年第4期19-22,共4页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的 探讨聚甲基丙烯酸甲酯（polymethvlmethacnrlat,PMMA）增强的多孔中空椎弓根螺钉加单枚椎间融合器治疗腰椎滑脱症合并骨质疏松患者的安全性及疗效.方法 2012年4月～2013年5月收治26例合并骨质疏松的腰椎滑脱症患者,均应用PMMA增强多孔中空椎弓根螺钉行短节段固定复位加单枚椎间融合器（cage）融合手术治疗.对16例骨质疏松及滑脱不严重患者采用单一病椎多孔中空骨水泥螺钉加普通椎弓根螺钉固定,10例骨质疏松或滑脱较重患者采用双椎体多孔中1空骨水泥螺钉固定.测量术前及术后末次随访时椎间隙高度、椎间孔高度、滑脱距离、滑脱率及滑脱角.结果 术中出现骨水泥漏2例,术中及术后无不适.并发硬脊膜损伤2例,经缝合修复后无脑脊液渗漏.1例术后出现健侧下肢放射痛并麻木,行翻修手术后症状消失.9例Ⅰ度滑脱、12例Ⅱ度滑脱患者术后解剖复位,3例Ⅱ度滑脱和2例Ⅲ度滑脱患者留有Ⅰ度滑脱.随访12～30个月,平均23.3个月.术后末次随访时椎间隙高度、椎间孔高度、滑脱距离、滑脱率及滑脱角与术前比较均有统计学差异（P＜0.05）.根据Nakai评分标准,优良率为88.46％.随访期间,全部病例固定节段的椎体间无位移,滑脱无复发.无椎弓根螺钉松动、断裂,无椎间隙塌陷.融合成功24例,融合率92.3％.结论 采用PMMA增强的多孔中空椎弓根螺钉加单枚椎间融合器治疗合并骨质疏松腰椎滑脱症安全有效.Objective Observing the safety and efficacy of PMMA reinforced porous hollow pedicle screw plus single pieces interbody fusion for treatment of patient with lumbar spondylolisthesis and osteoporosis. Methods We included 26 patients with lumbar spondylolisthesis and osteoporosis from April 2012 to May 2013, and all were applied PMMA reinforced porous hollow pedicle screw for short-segment reduction fixation plus single pieces interbody fusion cage for fusion surgery. 16 patients with less severe osteoporosis and spondylolisthesis were applied single vertebral bone cement porous hollow screw and common pedicle screw fixation, while 10 cases of patients with more severe osteoporosis or spondylolisthesis were applied double vertebral bone cement porous hollow screw fixation. Measurements include intervertebral height, foraminal height, slip away, slip rate and slip angle before surgery and last follow-up after surgery. Results 2 patients went through bone cement leakage in surgery, but no intraoperative and postoperative discomfort. 2 patients supervene with endorachis injury, but no leakage after suture repair. In One case we observed postoperative contralateral sciatica and numbness, but symptoms disappeared after revision surgery. We observed anatomical reduction in 9 patients with grade I spondylolisthesis and 12 patients with grade H spondylolisthesis, and grade I spondylolisthesis left in 3patients with grade II spondylolisthesis and 2 patients with grade III spondylolisthesis. Intervertebral height, foraminal height, slip away, slip rate and slip angle were measured when last follow-up after surgery, and compared with those parameters before surgery they were statistically significant （P〈0.05）. According to Nakai score, good rate was 88.46%. During follow-up, all cases didn＇t show fixed inter-vertebral segments displacement, slippage recurrence, pedicle screw loosening, fracture and disc space collapse. Successful integration in 24 cases means the fusion rate was 92.3%. Conclusion PMMA reinforced porou

关 键 词：腰椎滑脱症 骨质疏松 PMMA增强的多孔中空椎弓根螺钉 椎间融合器 

分 类 号：R687.3[医药卫生—骨科学]