长节段椎弓根螺钉矫形术固定治疗退变性腰椎侧凸伴骨质疏松症

Clinical analysis of long segment pedicle screw fixation orthopmorphia in the treatment of degenerative lumbar scoliosis patients with osteoporosis

目的探讨改良长节段椎弓根螺钉矫形术治疗退变性腰椎侧凸伴骨质疏松症的临床疗效。方法对26例退变性腰椎侧凸伴骨质疏松患者行长节段椎弓根螺钉矫形术,术中通过使用深螺纹螺钉、增大螺钉的外展角度、钉道内植骨等方法,术前进行Oswestry下腰痛功能障碍问卷调查表(ODI评分)及腰腿痛评分,术后平均随访20.8个月(8个月～3年),末次随访时进行ODI评分及腰腿痛评分,比较术前和术后ODI评分及腰腿痛评分。结果 26例患者全部获得随访,术后ODI评分较术前明显减少(P<0.05);术后腰腿痛评分较术前显著增加,下肢功能明显改善(P<0.05)。本组22例获得优良手术效果,优良率为84.6%。结论改良长节段椎弓根螺钉矫形术治疗退变性腰椎侧凸伴骨质疏松症是一种切实可行的手术方式,手术疗效明确。术中使用深螺纹螺钉、增大螺钉的外展角度、钉道内植骨是手术成功的关键。

Objective To evaluat the effectiveness of long segment pedicle screw fixation orthopmorphia in the treatment of degenerative lumbar scoliosis patients with osteoporosis.Methods 26 patients with degenerative lumbar scoliosis and osteoporosis underwent improved long segment pedicle screw fixation orthopmorphia,during surgical operation use of screw with deep thread,enlarging abduction angle of screw and grafing bone in the opening of screw and so on,lumbago oswestry disability index（ODI） and the pain in waist and lower extremities grades were tested before operation,all patients had an average follower-up period of 20.8 months（8 months to 3 years）,then lumbag ODI scores and the pain in waist and lower extremities grade were tested at last follow-up,lumbag ODI and the pain in waist and lower extremities grades were compared.Results All 26 patients had a followed-up.Postoperative ODI had significant lower than that of preoperative,there was a significant difference（P 0.05）,the pain in waist and lower extremities grades had significantly improved;the function of lower extremities grades had distinct improvement,there was a significant difference（P 0.05）.22 patients had satisfactory operation results,with excellent and good ratio of 84.6%.Conclusion Improved long segment pedicle screw fixation orthopmorphia is feasible to the patients with lumbar scoliosis and osteoporosis,with significant therapeutic effect.Using of screw with deep thread,enlarging abduction angle of screw and grafing bone in the opening of screw is the key to ensure success of the surgery.