可注射骨水泥椎弓根钉内固定术治疗伴骨质疏松的多节段腰椎管狭窄症的疗效  

Efficacy of injectable cement pedicle screw internal fixation in treatment of multisegmental lumbar spinal stenosis with osteoporosis

作　　者：陈斌伟[1] 廖壮文[1] 黄帅 刘圣曜 CHEN Binwei;LIAO Zhuangwen;HUANG Shuai;LIU Shengyao(Department of Orthopedic,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China)

机构地区：[1]广州医科大学附属第二医院骨科

出　　处：《实用医学杂志》2019年第24期3793-3797,共5页The Journal of Practical Medicine

基　　金：广东省科学技术厅科技计划项目(编号：2017ZC0247)

摘　　要：目的探讨可注射骨水泥椎弓根钉内固定术治疗伴骨质疏松的多节段腰椎管狭窄症的疗效。方法回顾性队列研究2013年1月至2017年5月我院采用后路单纯腰椎管减压椎弓根钉内固定术治疗的60例伴骨质疏松的多节段腰椎管狭窄症患者,将30例应用可注射骨水泥强化椎弓根钉设为观察组,30例应用常规椎弓根钉设为对照组,均随访2年以上。比较两组病例手术时间、术中和术后出血量、手术并发症及内固定螺钉松脱率情况;比较术前、术后6个月及末次随访时行VAS评分、ODI指数评价临床疗效。结果观察组手术时间比对照组手术时间多,差异具有统计学意义(P<0.01),两组术中、术后出血量差异无统计学意义(P>0.05)。两组病例术后6个月、末次随访的VAS评分和ODI指数均较术前改善,差异具有统计学意义(P<0.05),而两组间各时段的VAS评分和ODI指数对比无统计学差异(P>0.05);观察组中随访期间无螺钉松动,对照组中2例(6.7%,2/30)患者共发生4枚螺钉出现松动。结论对于伴骨质疏松的多节段腰椎管狭窄症的手术治疗时,可注射骨水泥椎弓根具有更好的固定作用,但增加手术时间,建议在病情条件允许时实行可注射骨水泥椎弓根钉技术。Objectives To investigate the efficacy of injectable cement pedicle screw internal fixation in the treatment of multisegmental lumbar spinal stenosis with osteoporosis Methods Retrospective cohort study of 60 patients with multisegmental lumbar spinal stenosis and osteoporosis treated with posterior lumbar decompression and pedicle screw internal fixation in our hospital from January 2013 to May 2017 was conducted and both patients were followed up for a minimum of 2 years. Thirty patients with injectable bone cement to strengthen the pedicle screw were involved as observation group and another thirty treated with traditional pedicle screw as control group.Operative time,intraoperative and postoperative blood loss,surgical complications and pedicle screws looseness rate were compared. The clinical efficacy was evaluated by VAS score and ODI index before operation,6 months after operation and at the last follow-up. Results The operation time in the observation group was longer than that in the control group,and the difference was statistically significant(P < 0.01). There was no significant difference in intraoperative and postoperative blood loss between the two groups(P > 0.05). VAS score and ODI index 6 months after operation and at the last follow-up in the two groups were significantly improved than those before operation(P < 0.05). There was no significant difference in VAS score and ODI index at any time between the two groups.There was no screw loosening in the observation group during the follow-up period,but 4 occurred in 2 patients(6.7%,2/30)in the control group. Conclusion For surgical treatment of multisegmental lumbar spinal stenosis with osteoporosis,the injection of bone cement pedicle has a better fixation effect,but the operation time is increased. It is suggested that injectable bone cement pedicle nail technique should be carried out when permitted.

关 键 词：可注射骨水泥椎弓根钉 骨质疏松 多节段腰椎管狭窄症 

分 类 号：R68[医药卫生—骨科学]