| 孟 冰,刘趁心,杨 照,杨晓江,王新力,徐 超,魏 伟,卢昌波,吴子祥,雷 伟.新型骨水泥椎弓根螺钉在治疗腰椎滑脱合并骨质疏松症的应用研究[J].,2019,19(8):1476-1481 |
| 新型骨水泥椎弓根螺钉在治疗腰椎滑脱合并骨质疏松症的应用研究 |
| Application of a New-structured Polymethylmethacrylate-augmented Fenestrated Pedicle Screw in the Treatment of Lumbar Spondylolisthesis Complicated with Osteoporosis |
| 投稿时间：2018-10-24 修订日期：2018-11-20 |
| DOI：10.13241/j.cnki.pmb.2019.08.017 |
| 中文关键词: 空心侧开孔椎弓根螺钉 腰椎滑脱 骨质疏松 骨水泥 脊柱手术 |
| 英文关键词: Fenestrated pedicle screw Osteoporosis Lumbar spondylolisthesis Bone cement Spine surgery |
| 基金项目:国家自然科学基金项目（81672132） |
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| 中文摘要: |
| 摘要 目的：探讨评估聚甲基丙烯酸甲酯（polymethvlmethacnrlat, PMMA）增强的具有“渐变孔”结构的侧开孔中空椎弓根螺钉（Fenestrated pedicle screw, FPS）治疗腰椎滑脱症的安全性及疗效。方法：回顾性分析2013年1月~2017年12月收治32例合并有骨质疏松症的腰椎滑脱患者，均应用具有“渐变孔”结构的FPS融合手术治疗，记录手术时长、术中出血量，住院时长；测量椎间隙高度、椎体楔形变指数、滑脱距离、滑脱角、骨盆指数、腰椎前凸角；随访评估Oswestry 功能障碍指数问卷表（Oswestry Disability Index Questionnaire, ODI）评分和视觉模拟评分法（Visual Analogue Score, VAS）评分，比较分析术前、术后及末次随访时的差异；结果：术中X线及术后三维CT检查发现3枚渗漏的骨水泥螺钉（2.2 %），均为Yeom C型，术后无不适。随访7~61个月（平均34.9个月），滑脱复位良好，后凸畸形和矢状位失衡矫正良好，ODI评分和VAS评分均较术前有显著改善（p＜0.05）。随访期间，全部病例滑脱无复发，无椎弓根螺钉松动、断裂，无椎间隙塌陷，根据SUK标准融合成功率100 %。结论：新型骨水泥螺钉能够提供良好的固定稳定性，并且能够避免骨水泥渗漏发生以及螺钉松动脱出，为骨质疏松脊柱手术提供一种新的选择。 |
| 英文摘要: |
| ABSTRACT Objective: This study evaluates the safety and efficiency of the new-structured polymethvlmethacnrlat (PMMA)-augmented fenestrated pedicle screw (FPS) in the treatment of lumbar spondylolisthesis with osteoporosis (OP). Methods: The authors retrospectively reviewed 32 patients suffering from the lumbar spondylolisthesis and osteoporosis that were performed with posterior lumbar interbody fusion (PLIF) surgery between January 2013 to December 2017. The new-structured FPS were instrumented in all 32 patients. Record the duration of surgery, the amount of intraoperative blood loss and the length of hospital stay. Measure the radiological data, and take the Oswestry Disability Index Questionnaire (ODI) score and Visual Analogue Score (VAS) scores at pre-operation, post-operation and the last follow-up. The differences between preoperative, postoperative, and last follow-up were compared. Results: 3 FPSs in this study (rate 2.2%) occurred intraoperative cement leakage, all of which were Yeom type-C; however, there was no post-operation discomfort. After 7-61 months follow-up (mean 34.9 months), all slipping vertibrae got good reduction, kyphosis and sagittal imbalance were well corrected, and the improvement rate of ODI score and the improvement rate of VAS score were significantly improved compared with preoperative (p<0.05). During the follow-up period, all cases had no recurrence of spondylolisthesis, no screw loosening or facture, no intervertebral space collapse, and the fusion rate was 100% according to the SUK standard. Conclusion: This new type of cement-augmented pedicle screws can provide excellent fixation stability, and can avoid cement leakage and screw loosening. It provides a novel fixation option for the osteoporosis patients. |
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