骨水泥强化椎弓根钉固定在骨质疏松脊柱手术中的应用研究

Clinical analysis of patients receiving vertebra pedical nail strengthened by bone cement

目的探讨骨水泥强化椎弓根钉固定在骨质疏松脊柱手术中的临床应用价值。方法将48例脊柱退变患者随机分成治疗组、对照组各24例，均行常规椎弓根钉固定术，治疗组在植入螺钉前于椎弓根钉道注入聚甲基丙烯酸甲醋（PMMA）骨水泥。观察比较两组疼痛状况（VAS）评分、脊柱稳定性、神经症状（JOA）评分等。结果治疗组VAS评分：术前（7．21±1.01）分、术后1个月（3．12±1．65）分、术后6个月（3．08±1．10）分、术后12个月（3．09±1．25）分，对照组分别为（7．23±1．98）分、（4.31±2．13）分、（4．22±1．48）分、（4．12±1．34），两组在术后1个月、6个月、12个月VAS评分差异均有统计学意义（t=2．15、2．08、1．97，均P〈0．05）。治疗组脊柱稳定23例、不稳定1例，对照组分别为19例、5例，两组差异有统计学意义（χ2=5．031，P〈0．05）。治疗组JOA评分：术前（14．12±2．65）分、术后1个月（26．76±4．36）分、术后6个月（26．78±2．10）分、术后12个月（26．96±1．89）分，对照组分别为（14．41±2．13）分、（24．13±5．28）分、（24，32±1，68）分、（24．32±1．99）分，两组术前JOA评分差异无统计学意义（P〉0．05），两组术后1个月、6个月、12个月JOA评分差异均有统计学意义（t=3．54、3．39、3．56，均P〈0．05）。结论骨水泥强化椎弓根钉固定在骨质疏松脊柱手术中可明显改善疼痛及神经症状，增强脊柱稳定性，提高临床疗效。

Objective To evaluate the clinical effect of vertebra pedical nail strengthened by bone cement. Methods 48 cases with vertebral illness were divided into two groups ,each group of 24 cases. One group goes ahead of the restvertebra pedical nail dishpour into viscous polymethyl methacrylate （PMMA） , another group fixed by regular vertebra pedical nail. VAS score ,spinal stability and JOA score were adopted to evaluate curative effect synthetically. Results After 1 month ,6 months, 12 months, the VAS scores in the treatment group were （3.12 ± 1.65 ） , （3.08 ± 1.10）, （ 3.09 ± 1.25 ）, and the VAS scores in the control group were （ 4.31 ± 2.13 ）, （4.22 ±1.48 ）, （ 4.12 ± 1.34） ,the VAS scores had statistically significant differences between the two groups postoperative 1 month, 6 months,12 months（t =2.15,2.08,1.97 ,all P 〈0.05） ;after 1 month,6 months, 12 months JOA scores in the treatment group were（26.76 ± 4.36 ） , （ 26.78 ± 2.10） , （ 26.96 ± 1.89 ）, and JOA scores in the control group were （24. 13 ± 5.28 ）, （24.32 ± 1.68）, （24.32 ±1.99 ）, the JOA score differences had statistically significances between the two groups （ χ2 = 5.031, P 〈 0.05 ） ; the excellent rates of the treatment group was 90.13%, which was higher than 85.01% of the control group （ t = 3.54,3.39,3.56, all P 〈 0.05 ）. Conclusion Patients receiving vertebra pedical nail strengthened by bone cement was better than regular vertebra pedical nail skill.