骨水泥强化椎弓钉用于骨质疏松腰椎手术二次置钉  

Bone cement-augmented pedicle screw for secondary screw placement during lumbar spine surgery in osteoporotic condition

作　　者：陈晓峰[1] 郭伟俊[1] 蔡东岭[1] 梁志洪 韩桩汛 褚学远 劳泽辉[1] 欧志聪 李浩 CHEN Xiao-feng;GUO Wei-jun;CAI Dong-ling;LIANG Zhi-hong;HAN Zhuang-xun;CHU Xue-yuan;LAO Ze-hui;OU Zhi-cong;LI Hao(Department of Orthopedics and Traumatology,Panyu District Hospital of Traditional Chinese Medicine,Guangzhou 511400,China)

机构地区：[1]广州市番禺区中医院骨伤科,广东广州511400

出　　处：《中国矫形外科杂志》2021年第10期875-879,共5页Orthopedic Journal of China

基　　金：广州市番禺区医疗卫生重点学科项目(编号:2019-Z04-08)。

摘　　要：[目的]比较骨水泥注入钉道后再次置入普通椎弓根螺钉(conventional pedicle screw with cement augmentation,CPSCA)与更换侧孔空心椎弓螺钉再注入骨水泥进行钉道强化(fenestrated pedicle screws with cement augmentation,FPSCA)在二次置钉条件下治疗骨质疏松患者腰椎退行性疾病的临床效果。[方法]回顾性分析78例行单节段后路椎间植骨融合的骨质疏松患者,其中有1枚二次置钉,并行骨水泥钉道强化。43例采用CPSCA,35例采用FPSCA。比较两组围手术期、随访和影像资料。[结果]两组患者均顺利完成手术,两组患者在总手术时间、术中失血量和术后住院时间、骨水泥渗漏率及早期并发症发生率的差异均无统计学意义(P>0.05)。两组患者随访12个月以上,随时间推移,两组患者腰痛VAS、腿痛VAS和ODI评分均显著下降(P<0.05)。术后3和6个月时,FPSCA组的腰痛VAS、腿痛VAS和ODI评分均显著小于CPSCA组(P<0.05)。影像方面,随术后时间推移,两组患者螺钉松动率和椎间融合率均显著增加(P<0.05)。[结论]在二次置钉条件下,FPSCA骨水泥强化技术优于CPSCA骨水泥强化技术。[Objective] To compare the clinical outcomes of conventional pedicle screws with cement augmentation(CPSCA) versus fenestrated pedicle screws with cement augmentation(FPSCA) for secondary screw placement during pedicle screw fixation for lumbar degenerative diseases in osteoporotic condition. [Methods] A retrospective study was conducted on 78 patients with osteoporosis who underwent single-segment posterior instrumented fusion with only one pedicle screw reinsertion. Among them, 43 patients received CPSCA, and the other 35 patients underwent FPSCA. The two groups were compared regarding documents of perioperative period, follow-up and radiographs. [Results] The patients in both groups were successfully operated. There was no significant difference in total operation time, intraoperative blood loss, postoperative hospital stay, bone cement leakage rate and early complication rate between the two groups(P>0.05).The patients in the two groups were followed up for more than 12 months. The VAS scores of low back pain and leg pain, as well as ODI scores decreased significantly in both groups over time(P<0.05). At 3 and 6 months after surgery, the FPSCA group had significantly lower VAS scores of low back pain and leg pain, as well as ODI score than the CPSCA group(P<0.05). In terms of imaging, both the screw loosening rate and intervertebral fusion rate in the two groups increased significantly as time went postoperatively(P<0.05). [Conclusion] Under the condition of secondary screw placement, fenestrated pedicle screw with cement augmentation technique is better than conventional pedicle screw with cement augmentation technique.

关 键 词：骨质疏松 椎弓钉固定 二次置钉 侧孔空心椎弓根钉骨水泥强化 普通椎弓钉骨水泥强化 

分 类 号：R687[医药卫生—骨科学]