【摘要】 目的观察可注射骨水泥椎弓根螺钉系统联合椎间融合治疗腰椎滑脱并骨质疏松症的临床效果。方法回顾性分析2013年8月-2015年11月接受可注射骨水泥椎弓根螺钉系统联合椎间融合治疗的21例腰椎滑脱症并骨质疏松症患者的临床资料。21例患者中男9例,女12例,年龄60~80岁,平均64岁;退变性滑脱6例,峡部裂性滑脱15例;Ⅰ度滑脱2例,Ⅱ度滑脱13例,Ⅲ度滑脱6例;均为单节段滑脱,L4滑脱9例,L5滑脱12例。所有患者均行全椎板切除减压、可注射骨水泥椎弓根螺钉系统植入、椎间隙撑开复位固定融合术。术前、术后3个月和末次随访时测量椎间隙高度、椎间孔高度、滑脱距离、滑脱率及滑脱角并进行Oswestry功能障碍指数(ODI)评分,随访椎间融合情况。结果术后2例发生切口脑脊液漏,采取切口加压包扎、头低脚高位、脱水等治疗后得以控制,切口按期拆线。21例患者术后滑脱均有不同程度复位,腰椎生理曲度恢复。术后3个月椎间隙高度、椎间孔高度均明显高于术前(P<0.05),而滑脱距离、滑脱率、滑脱角及ODI评分均明显低于术前(P<0.05);随访16~26个月,平均20.5个月,末次随访时上述各指标与术前比较差异均有统计学意义(P<0.05),而与术后3个月比较均无明显差异(P>0.05)。按照ODI评分判定疗效,术后3个月及末次随访时的优良率分别为90.6%及92.5%,随访期间矫正程度无丢失,螺钉无松动,融合成功19例,成功率为90.5%。结论采用可注射骨水泥椎弓根螺钉系统联合椎间融合治疗腰椎滑脱并骨质疏松症效果满意。更多还原

【Abstract】 Objective To observe the therapeutic effect of bone cement injectable pedicle screw system combined with inter vertebral fusion for lumbar spondylolysis and osteoporosis. Methods The clinical data were analyzed retrospectively of 21 patients with lumbar spondylolysis and osteoporosis who received treatment of bone cement injectable pedicle screw system and intervertebral fusion from Aug. 2013 to Nov. 2015. The 21 patients(9 males and 12 females) aged from 60 to 80 years(mean 64 years old); 6 of them presented degenerative spondylolysis, 15 with isthmic spondylolisthesis; 2 cases had I degree slippage, 13 had Ⅱ degree slippage, 6 had Ⅲ degree slippage, and all the cases were unisegmental slippage including 9 cases in L4 and 12 cases in L5. Bone mineral density of lumbar vertebrae(L2-L5) was measured with dual-energy X-ray absorptiometry, and T values conforming to the diagnostic criteria of osteoporosis were less than or equal to-2.5; All patients were operated with whole lamina resection for decompression, bone cement injectable pedicle screws system implantation, propped open reduction and fixation intervertebral fusion. The clinical outcomes were determined by the radiographic evaluation including intervertebral height, height of intervertebral foramen, slip distance, slip rate and slip angle, and Oswestry disability index(ODI) on preoperative, 3 months after operation and the end of the time, and the interbody fusion were followed up. Results Cerebrospinal fluid leakage of incision was observed in two cases after operation, compression and dressing to incision, Trendelenburg position, dehydration and other treatments were taken, and the stitches of incisions were taken out on schedule. Slips in the 21 patients were reset to different extent, and lumbar physiological curvatures were recovered. The intervertebral height and height of intervertebral foramen were obviously higher 3 months after operation than that before operation(P<0.05), and the slip distance, slip rate, slip angle and ODI scores were markedly shorter or smaller 3 months after operation than that before operation(P<0.05). Follow-up was done for 16-26 months(average of 20.5 months). All the judgment indexes mentioned above were statistically different in the last following up than that before operation(P<0.05), but no significant difference compared to that of 3 months after operation(P>0.05). Based on the ODI score, the excellent/fine rate was 90.6% and 92.5% for 3 months after operation and the last follow-up, respectively. During the period of following up, no loss of the correction degrees, no loosening of the screws, and 19 cases were noted bony fusion with the fusion success rate of 90.5%. Conclusion The treatment effect of bone cement injectable pedicle screw system and intervertebral fusion for lumbar spondylolysis and osteoporosis is satisfied.更多还原