骨水泥强化椎弓根螺钉内固定治疗伴骨质疏松腰椎退行性疾病的1年随访  

Bone cement pedicle screw fixation and fusion in the treatment of degenerative spinal disease with osteoporosis:one-year follow-up

作　　者：侯广原 张继学[2] 张志军[2] 孟祥晖[2] 段文[2] 高维陆[1] Hou Guangyuan;Zhang Jixue;Zhang Zhijun;Meng Xianghui;Duan Wen;Gao Weilu(Department of Orthopedics,First Affiliated Hospital of Anhui Medical University,Hefei 230022,Anhui Province,China;Department of Orthopedics,Anhui Provincial Cancer Hospital,Hefei 230031,Anhui Province,China)

机构地区：[1]安徽医科大学第一附属医院骨科,安徽省合肥市230022 [2]安徽省肿瘤医院骨科,安徽省合肥市230031

出　　处：《中国组织工程研究》2021年第6期878-883,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金面上项目(81871785),项目参与人:高维陆、侯广原。

摘　　要：背景:椎弓根螺钉内固定系统是脊椎外科手术常用治疗方案,对于骨脆性较大的老年患者来说,骨骼弹性不足,对椎弓根螺钉的把持力不够,从而有螺钉松动、拔出的风险,导致脊柱复位和固定失败,所以需要探索新的方式来增加椎弓根螺钉系统的稳定性。目的:探究应用骨水泥强化椎弓根螺钉内固定治疗伴有骨质疏松的不同类型腰椎退行性病变的远期疗效。方法:纳入60例伴骨质疏松的腰椎退行性病变患者,随机分为对照组及试验组,每组30例,完善术前检查及X射线片、CT、MRI检查。对照组使用常规椎弓根螺钉技术,试验组在对照组基础上加用骨水泥治疗,比较2组患者术前1 d及术后1周、6个月、1年的疼痛目测类比评分、Oswestry功能障碍指数,并观察术后并发症发生情况,以此来评价手术疗效。结果与结论:①2组患者中,术后1周、6个月及1年的目测类比评分、Oswestry功能障碍指数均优于术前,差异有显著性意义(P<0.05);术后6个月、1年目测类比评分、Oswestry功能障碍指数均低于术后1周,差异有显著性意义(P<0.05);术后1年的目测类比评分、Oswestry功能障碍指数均低于术后6个月,差异有显著性意义(P<0.05);②试验组术后6个月及1年的目测类比评分、Oswestry功能障碍指数均优于对照组(P<0.05);③试验组术后内固定棒松动发生率低于对照组;④说明应用骨水泥强化椎弓根螺钉内固定技术治疗伴有骨质疏松的腰椎退行性病变时,可以有效改善患者临床症状,减少并发症的发生,在临床应用中安全有效,长期治疗效果尚可。BACKGROUND:Even pedicle screw fixation system is commonly used in spinal surgery,elderly patients with high bone fragility lack of bone elasticity,insufficient holding power of pedicle screw.Thus,there is a risk of loosening and pulling out the screws,leading to failure of spine reduction and fixation.Thus,we need to explore new method to increase the stability of the pedicle screw system.OBJECTIVE:To explore the long-term effect of pedicle screw internal fixation with bone cement in the treatment of different types of lumbar degenerative diseases with osteoporosis.METHODS:Sixty patients suffering from degenerative spinal disease with the complication of osteoporosis were randomly assigned to control group and trial group(n=30 per group).Before adopting the treatment of bone cement pedicle screw fixation and fusion,all patients had taken pre-operation examination,X-ray,CT and MRI scan.The patients in the control group were treated with conventional pedicle screw technology,and those in the experimental group were treated with bone cement on the basis of the conventional pedicle screw technology.Visual analogue scale score and Oswestry disability index were compared between the two groups 1 day before surgery,1 week,6 months,and 1 year after surgery.Complications were observed after surgery to evaluate the effect of the operation.RESULTS AND CONCLUSION:(1)At 1 week,6 months and 1 year after surgery,the visual analogue scale score and Oswestry disability index were significantly better than those of pre-operation(P<0.05).Visual analogue scale score and Oswestry disability index were significantly lower at 6 months and 1 year after surgery than those 1 week after surgery(P<0.05).Visual analogue scale score and Oswestry disability index were significantly lower at 1 year than those at 6 months after surgery(P<0.05).(2)Visual analogue scale score and Oswestry disability index were better in the trial group than those in the control group at 6 months and 1 year after surgery(P<0.05).(3)The incidence of internal fixatio

关 键 词：骨 骨质疏松 腰椎 退行性变 骨水泥 椎弓根螺钉 内固定 融合 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]