骨水泥强化治疗骨质疏松症伴脊柱侧弯疗效分析

Effects of pedicle screw fixation with bone cement tract augmentation on scoliolosis accompanying osteoporosis

目的探讨对伴骨质疏松症的退行性脊柱侧弯病人行后路减压、骨水泥强化钉道椎弓根内固定融合治疗的临床疗效。方法 2006-10-2009-07收治伴骨质疏松症的退变性脊柱侧弯患者18例,女11例,男7例,平均年龄64.5岁,均冠状面畸形,Cobb’s角〉15°或合并椎体旋转半脱位以及合并椎体骨质疏松性病理性骨折。手术采取部分椎板切除,松解神经根以充分减压,骨水泥强化钉道的椎弓根长节段钉棒系统进行矫形,记录手术前后Cobb’s角、前凸角,手术前后进行ODI评分。结果所有病例切口均Ⅰ期愈合,无感染或深静脉血栓等近期并发症;进行24~54个月随访（平均36个月）,未出现断钉、断棒,及椎弓根钉拔出、松动、融合节段假关节形成或感染等远期并发症。患者术后冠状面Cobb’s角均低于术前（P〈0.05）,腰椎矢状面前凸角均高于术前（P〈0.05）,ODI综合评分均低于术前（P〈0.05）。结论在充分减压消除症状的基础上,用骨水泥强化钉道进行侧弯的矫形,可以获得脊柱平衡并能够避免矫形的丢失。

Objective To evaluate the clinical effcct of the treatment that part or full laminectomy and correction with posterior long segment pedicle screw/rod internal fixation system by augmentation and restoration with bone cement in the screw tract and posterolateral or intervertebral spinal fusion.about degenerative scoliolosis accompanying with osteoporosis.Methods Eighteen patients,11 females and 7 males（average age of 64.5 years）,with degenerative scoliosis accompanying by osteoporosis were selected from our hospital,between October 2006 and July 2009.The patients were treated with part or full laminectomy and posterior long segment pedicle screw/rod internal fixation system by augmentation and restoration with bone cement in the screw tract and posterolateral or intervertebral spinal fusion.Result All cases were followed up for 36 months（range 24-54 months）.No incision infection,or no screw rod breakage,screw extraction,loosening,pseudoarticulation formation were found.The postoperative Cobb＇s angle in coronal plane was significantly lower than preoperative angle（P〈0.05）,and lordosis angle in sagittal plane was significantly higher than preoperative angle（P〈0.05）In addition,the post-operative ODI score was remarkably lower than preoperative score（P〈0.05）.Conclusion Degenerative scoliolosis accompanying by osteoporosis were well and long time retained of spine balance by part or full laminectomy and posterior long segment pedicle screw/rod internal fixation system by augmentation and restoration with bone cement in the screw tract and posterolateral spinal or intervertebral fusion.