骨水泥椎体强化在骨质疏松患者行椎弓根钉内固定中的应用

Pedicle screw fixation after vertebral augmentation with bone cement in osteoporotic patients

目的探讨应用骨水泥行椎体强化后椎弓根钉固定的临床效果。方法回顾分析23例骨质疏松患者用聚甲基丙烯酸甲酯(PMMA)骨水泥行椎体强化加椎弓根钉固定后的临床结果,比较术后1周内的与复查时的X线片,观察内固定物有无松动、椎弓根钉周围有无透亮线出现。结果本组所有病例术后均获得随访,随访时间为6～33个月,平均为17个月。所有患者腰痛及下肢神经压迫症状均明显缓解,脊柱活动度改善21例(91.3%),无改善2例。脊柱侧凸均获不同程度改善,后凸畸形均明显改善。所有患者复查X线片均未发现椎弓根螺钉的松动及脱出,椎弓根螺钉周围均未发现有透亮线出现。结论对骨质疏松患者用PMMA行椎体强化椎弓根钉固定,可防止椎弓根钉的松动及脱落,有较好的临床效果。术中应注意操作技巧,确保无骨水泥渗漏。

Objective To study the clinical effect and safety of pedicle screw fixation after vertebral augmentation with polymethylmethacrylate in osteoporotic patients. Methods The clinical effect of pedicle screw fixation after vertebral augmentation with polymethylmethacrylate in 23 osteoporotic patients were retrospectively analysed. By comparing their X-ray manifestations within 1 week postoperative with that of several months postoperativ when the patients came to recheck, whether the screws were loosened or pulled-out and if there were any bright lines around screws were observed. Results All the cases were followed up, and the time was from 6 months to 33 months, with average time of 17 months. The symptom of back pain and nerval injury of lower extremities in all the patients relieved obviously. Range of spinal motion improved in 21 cased（91. 3% ）, no improved in 2 cases. Seoliosis and kyphosis deformity were corrected obviously. There were no screw loosening, pullout or bright lines around screw observed in the X-rays expression of all the cases. Conclusion Pedicle screw fixation after vertebral augmentation with polymethylmethacrylate in osteoporotic patients can prevent screw loosening and pullout, and can gain a satisfactory clinical outcome. The operation should be carefully performed during the procedure to ensure that no cement extravasate.