聚甲基丙烯酸甲酯和自体骨加强的椎弓根螺钉技术治疗退变性脊柱侧凸的临床疗效比较

Autogenous bone and polymethylmethacrylate augmentation of screw fixation for degenerative scoliosis

目的比较应用聚甲基丙烯酸甲酯（PMMA）和自体骨加强的椎弓根螺钉技术治疗合并骨质疏松的退变性脊柱侧凸的临床疗效。方法回顾性分析2000年12月至2006年12月手术治疗的31例伴骨质疏松的退变性脊柱侧凸患者，其中14例采用PMMA加强钉道，17例采用自体骨加强钉道。记录并发症等围手术期情况，比较手术前后及随访期间侧凸的矫正效果。结果两种手术除口服止痛药使用时间和手术费用外，其他临床数据差异无统计学意义，PMMA加强组中2例出现骨水泥渗漏，但未出现神经损伤的症状。结论两种手术对伴骨质疏松的退变性脊柱侧凸的临床疗效无明显差异，PMMA加强的椎弓根螺钉内固定融合术可减少口服止痛药的用量，但治疗费用相对较高，且存在骨水泥渗漏的风险。

Objective To compare the clinical effect of autogenous bone and polymethylmethacrylate （PMMA） augmentation of screw fixation in degenerative scoliosis with osteoporosis. Methods A retrospective analysis was conducted on 31 consecutive patients with degenerative scoliosis combined with osteoporosis who accepted pedicle screw fixation from December 2000 to December 2006. Fourteen of them underwent fixation with pedicle screw by augmentation with PMMA and the other 17 patients with autogenous bone. Peri-operative data were recorded. Preoperative, postoperative and final follow up corrective effects were compared. Results No significant difference was found in clinical data except for administration time of oral pain relief medicines and surgery cost between the two surgical strategies. Cement leakage was observed in 2 patients in PMMA augmentation group, but there was no evidence of nerve damage. Conclusion There is no difference in surgical effect between two surgery strategies on degenerative scoliosis combined with osteoporosis. Less oral pain medicines are taken in the polymethylmethacrylate-augmented pedicle screw fixation and fusion, but with much more cost and danger of cement leakage.