【摘要】 目的 比较两种骨水泥强化椎弓根螺钉固定技术治疗老年骨质疏松性腰椎退行性病变的近期疗效,探讨其对邻近节段退变的影响。方法 回顾性分析2013年10月至2016年10月贵州省骨科医院采用后路腰椎融合术治疗的60例老年腰椎退行性疾病合并骨质疏松症患者的临床资料,根据手术方式的不同分为A、B、C三组(每组20例),分别为单纯椎弓根螺钉组(对照组)、骨水泥强化空心侧孔椎弓根螺钉组、骨水泥钉道强化椎弓根螺钉组。评估三组患者术前、末次随访Oswestry功能障碍指数(ODI)和日本骨科协会(JOA)评分,比较三组患者椎间隙高度、椎体变形指数、固定节段上位椎体上终板凹陷角度、相邻上位椎体下终板凹陷角度以及固定节段Cobb角的差异。结果 (1)患者获得6～30个月随访,平均随访时间21个月,所有病例随访期间内固定位置良好,均无松动、断裂及滑移发生;B组、C组骨水泥渗漏分别为4、5例,术后CT及三维重建提示B组骨水泥强化主要集中在椎体部,椎弓根部强化较少,C组对椎体及椎弓根部均有一定强化效果。(2)三组患者末次随访ODI、JOA评分均较术前改善(P <0.05),但三组间比较差异无统计学意义(P>0.05)。(3)末次随访时三组椎间隙高度较术前和术后1个月减小,且B、C两组椎间隙高度和椎体变形指数小于A组,差异有统计学意义(P <0.05),但B、C两组间差异无统计学意义(P>0.05)。(4)术后1个月和末次随访时,三组患者固定节段上位椎体上终板凹陷角度均较术前增大,上位相邻椎体下终板凹陷角度则较术前减小,且B、C两组患者固定节段上位椎体上终板凹陷角度大于A组、上位相邻椎体下终板凹陷角度小于A组(P<0.05),B、C两组间比较差异无统计学意义(P>0.05)。(5)B、C两组术后1个月和末次随访时Cobb角改变值小于A组(P <0.05),但B、C两组间比较,差异无统计学意义(P>0.05)。结论 对于老年骨质疏松性腰椎退行性病变,椎弓根螺钉固定能有效缓解患者临床症状,提高患者生活质量;相较于单纯椎弓根螺钉固定术,两种骨水泥强化术式能增强术后骨质疏松性椎体的稳定性,但也存在骨水泥渗漏、邻近节段应力集中、加速邻近节段退变问题。更多还原

【Abstract】 Objective To compare short-term effects of two different surgical techniques of bone cement augmentation with pedicle screw fixation for treatment of osteoporotic elderly patients with degenerative lumbar diseases,and to explore the effects of two bone cement augmentation procedures on adjacent segment degeneration.Methods Clinical data of 60 osteoporotic elderly patients with degenerative lumbar diseases treated by posterior lumbar fusion from October 2013 to October 2016 in Guizhou Orthopedic Hospital were retrospectively analyzed.According to different procedures,patients were divided into group A(conventional pedicle screw),Group B(bone cement augmentation with fenestrated pedicle screw) and Group C(bone cement augmentation with conventional pedicle screw),with 20 patients in each group.Oswestry disability index(ODI),Japanese Orthopaedic Association(JOA) score,intervertebral height(IH),deformation index(DI),concave angle of the fixed lumbar vertebral upper endplate(CAVUE) and the upper adjacent vertebral body inferior endplate(CAVIE),as well as Cobb angle of the fixed segment were measured at preoperation,30 days after operation and the final follow-up,and compared among three groups.Results The patients were followed up for 6-30 months,with average of 21 months.Internal fixation position of all cases was good,and no loosening,fracture or slip occurred within the follow-up period.There were 4 cases of bone cement leakage in group B and 5 cases of bone cement leakage in group C.Postoperative CT and 3D reconstruction showed that in group B,bone cement augmentaion focused on vertebral body,while little reinforcement was found in vertebral pedicle,while in group C,there presented certain augmentation effects in all vertebral bodies and pedicles.ODI and JOA score of the three groups at the latest follow-up were improved compared with those before the operation(P <0.05),but there were no statistical differences among the three groups(P>0.05).At the final follow-up,IH in the three groups were decreased than those at preoperation and 30 days after operation,furthermore,IH and DI in group B and group C were smaller than that in group A,the differences had statistical significances(P <0.05),but there was no statistical difference between group B and group C(P>0.05).At 30 d postoperatively and final follow-up,CAVUE was increased and CAVIE was decreased compared with preoperative ones,and CAVUE were larger,and CAVIE were smaller in group B and group C than those in group A(P <0.05),while there were no significant differences between group B and group C(P>0.05).Changes of Cobb angle in group B and group C were smaller than those in group A at 30 d postoperatively and the last follow-up(P <0.05),but there was no statistical difference between group B and group C(P>0.05).Conclusions For osteoporotic elderly patients with degenerative lumbar diseases,pedicle screw fixation can effectively relieve the clinical symptoms and improve the quality of life of patients.Compared with the conventional pedicle screw fixation,both two bone cement augmentation procedures could maintain the stability of postoperative osteoporotic vertebral body better,but at the same time,attention should be paid to the problems in complications of bone cement leakage,as well as the stress concentration and degeneration acceleration of adjacent segment.更多还原