骨水泥螺钉强化固定伴骨质疏松腰椎滑脱症的稳定性及椎间融合

摘要

背景：对于骨质疏松严重的腰椎滑脱症患者，复位时易发生螺钉松动、拔出，或者修复后容易出现复位丢失及内固定失败，因此修复过程中提高椎弓根螺钉固定强度非常重要。目前有关骨水泥螺钉强化技术应用于伴骨质疏松腰椎滑脱症患者的报道较少。目的：探讨聚甲基丙烯酸甲酯骨水泥强化椎弓根螺钉置入内固定在伴骨质疏松腰椎滑脱症中的应用价值。方法：将2009年6月至2011年6月收治的27例伴骨质疏松的腰椎滑脱症患者纳入回顾性分析，均行聚甲基丙烯酸甲酯骨水泥强化椎弓根螺钉置入内固定治疗。采用 Oswestry 功能障碍指数、目测类比评分评价功能障碍与疼痛程度，治疗后以影像学检查评估内固定与融合情况，记录并发症。结果与结论：患者获得15-37个月随访。末次随访 Oswestry 功能障碍指数、目测类比评分均显著优于治疗前，差异有显著性意义(P <0.05)。治疗后影像学结果显示所有患者的骨水泥与骨质界面结合紧密，螺钉及骨水泥位置良好，未发生有症状的骨水泥渗漏，末次随访无内固定失败，患者均获椎间融合。提示聚甲基丙烯酸甲酯骨水泥可增加骨质疏松椎体中椎弓根螺钉的把持力，骨水泥钉道强化固定伴骨质疏松的腰椎滑脱症安全有效，可得到满意的固定稳定性及椎间融合。%BACKGROUND: In lumbar spondylolisthesis patients with severe osteoporosis, screw is easily loose and pul s out during reposition, or loss of reduction and internal fixation failure easily occur after repair. Therefore, it is very important to elevate the intensity of pedicle screw fixation during repair. At present, few studies concern application of bone cement screw enhancement technology in lumbar spondylolisthesis patients with osteoporosis. OBJECTIVE: To investigate the clinical value of augmented pedicle screw with polymethylmethacrylate for lumbar spondylolisthesis accompanied with osteoporosis. METHODS: From June 2009 to June 2011, 27 patients suffering from lumbar spondylolisthesis accompanied with osteoporosis were included in this retrospective study. These patients received augmented pedicle screw with polymethylmethacrylate. The levels of disability and pain were evaluated by Oswestry Disability Index and visual analog scale. The internal fixation and fusion were evaluated by radiological findings. Al complications were recorded. RESULTS AND CONCLUSION: Al cases were fol owed up for 15-37 months. Oswestry Disability Index and visual analog scale scores were significantly better in final fol ow-up than that pre-treatment (P < 0.05). Imaging results revealed that bone cement tightly connected to bone interface. The position of screw and bone cement was good. Symptomatic bone cement leakage was not found. No fixation failure was detected during final fol ow-up. Al patients achieved interbody fusion. These results suggested that polymethylmethacrylate bone cement could increase the gripping force of the pedicle screw in osteoporotic vertebral body. It is safe and effective to treat spondylolisthesis accompanied with osteoporosis with augmented pedicle screws. Satisfactory fixation stability and interbody fusion can be obtained.