空心侧孔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 fenestrated pedicle screw in lumbar spondylolisthesis accompanied with osteoporosis

作　　者：刘勇[1,2] 樊勇[1] 吴子祥[1] 蒋从斌[2] 张扬[1] 曾艳平[1] 杨超[1] 杨万波[2] 桑宏勋[1] 

机构地区：[1]第四军医大学西京医院骨科,陕西西安710000 [2]武警湖北省总队医院骨一科,湖北武汉430061

出　　处：《中国矫形外科杂志》2016年第5期390-394,共5页Orthopedic Journal of China

摘　　要：[目的]探讨空心侧孔椎弓根螺钉在腰椎滑脱伴骨质疏松患者的手术方法和固定效果。[方法]2012年4月~2013年5月收治的26例腰椎滑脱症患者,经骨密度检测均有不同程度骨质疏松,骨密度〈0.80 g/cm2,T值〈-2.5。术中应用骨水泥增强的空心侧孔椎弓根螺钉行复位固定,共42个椎体,置入空心侧孔椎弓根螺钉84枚,观察椎弓根螺钉术中及术后的稳定性和临床治疗效果。[结果]术中出现骨水泥漏2例,无临床严重不适。26例患者均获得随访,随访时间12~30个月,平均23.3个月。术后VAS评分较术前比较改善明显,滑脱椎体均复位良好,椎体间均获得骨性融合,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影出现。[结论]经空心侧孔椎弓根螺钉固定椎体,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 fenestrated pedicle screw for the treatment of lumbar spondylolisthesis accompanied with osteoporosis. [Methods] Twenty- six lumbar spondylolisthesis patients,all with varying degrees of osteoporosis by bone density testing（ BMD 0. 80 g / cm2,T value - 2. 5）,were enrolled and treated from April2012 to May 2013. All patients were treated with internal fixations of fenestrated pedicle screw during operations. Forty- two ver-tebrae, with eighty- four fenestrated pedicle screws were instrumented in this study. The stability of pedicle screws during and after the operation were observed. [Results] Two cases of bone cement leakage were found during surgery,without any discomfort. All vertebral slippage got good reduction. The VAS scoresafter operations improved significantly compared to those before the operation. All 26 patients were followed up for 12- 30 months,with a mean of 23. 3 months. All 26 patients achieved bone unions. The X- ray showed no fixation loose,no broken or drop,and no bright lines around the screws. [Conclusion] Fenestrated pedicle screw fixation can increase the holding force of pedicle screw. It can meet the request for mechanical stability of posterior spinal fixation for the treatment of lumber spondylolisthesis.

关 键 词：空心侧孔椎弓根螺钉 腰椎滑脱 骨质疏松 

分 类 号：R687.3[医药卫生—骨科学]