目的 评价新型可膨胀椎弓根螺钉(Thunder钉)在骨质疏松性腰椎椎体中固定的可靠性及其临床疗效.方法 随访2006年8月至2007年12月,应用Thunder钉治疗合并骨质疏松症的各种腰椎疾患42例(236枚螺钉),其中腰椎退行性疾病24例,腰椎结核二期后路融合手术8例,腰椎骨质疏松性压缩骨折6例,腰椎翻修手术4例.所有病例术前均行骨密度检查,患者腰椎骨密度平均下降2.6个标准差.术后处理与其他腰椎内固定术后患者相同.术后1周、3个月、半年、1年及2年随访患者,摄X线片并进行CT扫描三维重建,了解椎弓根螺钉稳定性及脊柱融合情况.结果42例患者均获平均16(12～24)个月的随访.术后3、6、12及24个月的影像学检查显示,所有Thunder钉位置良好,无螺钉松动、断裂迹象,评分平均值分别为3.0、3.0、2.9和2.9.脊柱骨融合于术后随时间延长趋于完善,骨融合评分平均值分别为2.3、2.5、3.0、3.0.所有患者临床症状缓解,疗效满意.结论 Thunder钉具有良好的钉-骨界面结合,能够提高螺钉在骨质疏松椎体中的固定强度,为脊柱融合提供良好的基础,临床疗效满意.%Objective To evaluate the clinical effect and reliability of a novel expandable pedicle screw (Thunder screw) in osteoporosis lumbar spine fixation and fusion. Methods From August 2006 to December 2007, 42 lumbar disorder patients with severe osteoporosis received expandable pedicle screw fixation with a total of 236 screws implanted. These patients included lumbar degenerative diseases 24 cases, lumbar tuberculosis 8 cases, lumbar compression fractures 6 cases, and revision surgery 4 cases. All patients underwent bone mineral density (BMD) scan. All patients had severe osteoporosis with a mean decrease of 2.6 standard deviations in BMD. The pre-operative and post-operative evaluation of the patients were collect-ed one week, 3 months, 6 months, 12 months and 24 months after surgery. The plain film and three-dimen-sional CT scanning were conducted to evaluate the spinal fusion rate and fixation effectiveness of the ex-pandable pedicle screws. Results The mean follow-up period was 16 months (ranged from 12 to 24 months). There was no loosening, broken or pullout of the expandable pedicle screws. Three, 6, 12 and 24 months after surgery, the score of screw stabilization was 3.0, 3.0, 2.9 and 2.9 respectively. The bone healing was clearly noticed in the area surrounding the screws, intervertebral bodies and posterolaterally. The fusion index was 2.3, 2.5, 3.0 and 3.0 respectively. The clinical symptoms were totally released and the clinical re-sults were satisfactory. Conclusion The expandable pediele screw fixation can achieve excellent screw-bone interface intergration, increase the fixation strength in osteoporosis lumbar spine, thus facilitate spine fusion. The novel expandable pediele screws can be a feasible approach for increasing fixation strength of pedicle screw in osteoporosis and revision spine surgeries.
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