钉道强化椎弓根螺钉固定治疗伴骨质疏松的腰椎管狭窄症：31例随访

摘要

目的：评价钉道强化椎弓根螺钉内固定治疗伴骨质疏松的腰椎管狭窄症的近期临床疗效。方法回顾性分析2011年7月至2012年3月采用带侧孔空心椎弓根螺钉内固定钉道强化术治疗的31例伴骨质疏松的腰椎管狭窄症患者，其中男6例，女25例，年龄55～85岁,平均（72.42±5.76）岁。所有患者术前骨密度检测均符合骨质疏松诊断（双能X线骨密度值测定≤-2.5）。结果31例患者均顺利完成手术，手术时间90～180 min，平均（120±23.66）min，出血量100～450 ml，平均（196.77±65.75）ml；术中无神经损伤，无硬膜撕裂，无严重骨水泥渗漏。术后复查X线片、CT显示：骨水泥分布均匀、对称。随访6～12个月，平均（10±1.79）个月,脊髓、神经根压迫症状均得到改善，疼痛VAS评分术前6.89±1.83、术后6个月随访为2.89±0.60、末次随访为2.33±1.01；术后6个月与术前比较差异有统计学意义（P＝0.001）；末次随访与术前对比差异有统计学意义（P＝0.000）。ODI功能障碍评分术前为0.63±0.25、术后6个月为0.27±0.06、末次随访为0.23±0.05；术后6个月与术前对比差异有统计学意义（P＝0.000）；末次随访与术前对比差异有统计学意义（P＝0.000）。JOA 评分术前为10.01±5.77、术后6个月随访为18.03±1.66、末次随访为18.22±1.30；术后6个月与术前对比差异有统计学意义（P＝0.003）；末次随访与术前对比差异有统计学意义（P＝0.001）。SF-36生存质量评分：生理功能（PF）术前为24.42±6.87、术后6个月随访为47.50±8.04、末次随访为86.51±2.39；术后6个月与术前对比差异有统计学意义（P＝0.002）；末次随访与术前对比差异有统计学意义（P＝0.001）。生理职能（RP）术前为2.81±7.58、术后6个月为24.82±9.33、末次随访为86.72±4.36；术后6个月与术前对比差异有统计学意义（P＝0.001）；末次随访与术前对比差异有统计学意义（P＝0.001）。躯体疼痛（BP）术前为28.92±10.00、术后6个月为44.70±15.45、末次随访为75.39±12.38，术后6个月与术前对比差异有统计学意义（P＝0.000）；末次随访与术前对比差异有统计学意义（P＝0.001）。社会功能（SF）术前为33.18±7.63、术后6个月为43.57±4.23、末次随访为73.81±7.36；术后6个月与术前对比差异有统计学意义（P＝0.001）；末次随访与术前对比差异有统计学意义（P＝0.006）。复查 X 线片示内固定位置满意无松脱。结论应用空心侧孔椎弓根螺钉对伴发骨质疏松的椎体行钉道强化固定，能够有效增强螺钉的把持力，早期恢复患者活动能力，提高近期临床疗效。%Objective To evaluate the clinic effect of pedicle screws with cement augmentation instrumentation for lumbar spinal stenosis with osteoporosis. Methods From July 2011 to March 2012, 31 cases with lumbar spinal stenosis and osteoporosis undergoing cement augmented pedicle screw instrumentation were included in our study.There were 6 males and 25 females;with the average age of 72.4 years (range, 60-85 years). Osteoporosis was diagnosed by dual-energy x-ray absorptiometry(DXA) examination in all cases preoperatively(BMD parameter≤-2.5). Results All the 31 cases underwent the operation successfully. The operation time was 90-180 min[(120±23.66)min], and the haemorrhage was 100-450 ml[(196.77±65.75)ml]. There were no complications such as neural or vascular injuries, spinal cord injuries or catastrophic cement leakage. The postoperative X-ray and CT scan showed that the cement distribution was symmetrical. After a follow-up of 6-12 months[(10± 1.79)months]of these 31 cases, clinical symptom caused by acute nerve-root or spinal cord compression had a significant improvement. The VAS, ODI, JOA and SF-36(PF, RP, BP, SF) scores improved from 6.89±1.83, 0.63 ±0.25, 10.01±5.77 and 24.42±6.87, 2.81±7.58, 28.92±10.00, 33.18±7.63 to 2.89±0.60, 0.27±0.06, 18.03± 1.66 and 47.50±8.04, 24.82±9.33, 44.70±15.45, 43.57±4.23 at six weeks postoperation;to 2.33±1.01, 0.23± 0.05, 18.22±1.30 and 86.51±2.39, 86.72±4.36, 75.39±12.38, 73.81±7.36 at the time of the latest follow-up. The differences between preoperative and six weeks postoperation were statistically significant(P=0.001, 0.000, 0.003, 0.002, 0.001, 0.000, 0.001). The differences between preoperative and the latest follow-up were also statistically significant(P=0.000, 0.000, 0.001, 0.001, 0.001, 0.001, 0.006). The postoperative check with X-ray showed good internal fixation. Conclusion The application of the cement augmented pedicle screws with hollow lateral holes can improve the screws holding strength and clinical efficacy on osteoporotic vertebrae.