骨水泥强化椎弓根螺钉技术应用于脊柱肿瘤外科治疗的临床疗效探究  

Effects of pedicle screw cement augmentation on spine tumor surgery

作　　者：钟南哲 严望军[1] 魏海峰[1] 刘铁龙[1] 肖建如[1] 杨兴海[1] 

机构地区：[1]第二军医大学附属长征医院骨肿瘤科,上海200003

出　　处：《中国骨与关节杂志》2016年第8期632-637,共6页Chinese Journal of Bone and Joint

摘　　要：目的探究骨水泥强化椎弓根螺钉技术应用于脊柱肿瘤合并邻近椎节骨质量不佳患者术后脊柱稳定性重建的有效性和安全性。方法回顾分析2012年12月至2014年11月,于我科采用骨水泥强化椎弓根螺钉技术治疗脊柱肿瘤合并邻近椎节骨质量不佳的35例患者术后脊柱稳定性重建的临床资料,其中男22例,女13例;年龄40-76岁,平均（58.1±8.5）岁。对术后骨水泥在椎体内的弥散情况及与椎体和螺钉的相对位置行具体探究。结果本组随访时间为14-37个月,平均（28.3±4.6）个月。随访时美国脊髓损伤协会（American spinal cord injury association,ASIA）、视觉模拟疼痛评分（visual analogue scale,VAS）较术前均有显著改善。后凸平均矫正率为54.8%,末次随访平均丢失角为0.6°,侧凸平均矫正率为71%,末次随访平均丢失角为0.3°。术前及术后冠状位Cobb’s角分别为（6.0±6.4）°和（1.5±2.3）°,术前及术后矢状位Cobb’s角分别为（14.1±12.8）°和（11.2±8.1）°,差异均有统计学意义;术后3个月与末次随访冠状位及矢状位Cobb’s角无明显改变。随访复查影像学显示所有患者椎间植骨融合情况良好,未发现手术相关并发症。无内固定失败事件发生。骨水泥多对称分布在螺钉尖端及钉道旁。骨水泥分布于前柱占73.4%,分布于前柱及中柱前部占26.6%。骨水泥弥散-钉道半径比95%CI：1.80-3.14,骨水泥弥散-钉道深度比95%CI：64.6%-92.2%,钉道-骨水泥弥散体积比95%CI：10.1%-40.6%,骨水泥弥散-椎体体积比95%CI：2.0%-20.2%,骨水泥弥散长度-椎体直径比95%CI：43.3%-66.1%。结论骨水泥强化椎弓根螺钉技术可安全有效地实现脊柱肿瘤合并邻近椎节骨质量不佳患者接受病灶切除术后脊柱的稳定性。有助于缓解患者局部疼痛、恢复脊髓神经功能及维持脊柱稳定性。而该内固定方法成功操作的关键在于获得合理的骨水泥弥散分布方式。Objective To evaluate the effectiveness and safety of cement-augmented pedicle screw fixation on spine tumor with osteoporotic adjacent vertebrae. Methods The medical records of 35 patients（ 22 males, 13 females） with spine tumors combined with adjacent vertebral osteoporosis were retrospectively analyzed. All underwent operation and were reconstructed by cement-augmented pedicle screw fixation from December 2012 to November 2014. The mean age was（ 58.1 ± 8.5） years（ range： 40- 76 years）. Characteristics of cement distribution, and the location of cement in the vertebrae and with screws were investigated. Results The mean follow-up time was（ 28.3 ± 4.6） months（ range： 14- 37 months）. Scores of American spinal cord injury association（ ASIA） and visual analogue scale（VAS） were all improved significantly at the last follow-up. The mean correction rate of kyphosis and scoliosis were 54.8% and 71% respectively with the average loss of angle 0.6° and 0.3° respectively. Preoperative and postoperative coronal Cobb＇s angles were（ 6.0 ± 6.4） ° and（ 1.5 ± 2.3） °, and preoperative and postoperative sagittal Cobb＇s angles were（ 14.1 ± 12.8） ° and（ 11.2 ± 8.1） °, with statistical significance. Coronal and sagittal Cobb＇s angles showed no significant changes 3 months postoperatively and in the latest follow-up. No operative complications, nonunion or instrumental failure were detected during the follow-up. 73.4% of cement distributed in the anterior column and the rest 26.6% in the anterior column and the anterior part of the medial column. 95% confidential interval（ CI） of the ratio between the diameter of cement distribution and screw：（ 1.80- 3.14）; the depth of cement distribution and screw：（ 64.6%- 92.2%）; the volume of screw and cement distribution：（10.1%- 40.6%）; the volume of cement distribution and vertebrae：（ 2.0%- 20.2%）; the depth of cement distribution and the diameter of vertebrae：（43.3%- 66.1%）. Conclusions Cement-a

关 键 词：骨水泥成形术 椎弓根钉 骨肿瘤 脊柱 

分 类 号：R738.1[医药卫生—肿瘤]