骨质疏松患者椎弓根螺钉稳定性的随访(英文)

Stability of pedicle screw in patients with osteoporosis: Follow-up visit

背景:骨质疏松患者置入椎弓根螺钉后,易发生螺钉松动和复位矫正丢失等固定不稳现象,因此,骨质疏松被认为是椎弓根螺钉的相对禁忌证。目的:观察骨质疏松患者提高椎弓根螺钉稳定性方法的临床应用效果。方法:34例骨质疏松患者行椎弓根螺钉内固定,术中采用了提高椎弓根螺钉稳定性方法。骨折患者14例(骨折组),骨病患者20例。20例骨病患者和5例骨折患者行脊柱后外侧或椎间植骨融合(融合组)。骨质疏松按Jikei分级,初级8例,Ⅰ级11例,Ⅱ级8例,Ⅲ级7例。对19例初级和Ⅰ级骨质疏松患者,采用较粗和较长螺钉,同时结合采用螺钉与连接棒强直性连接,且有两根横向连接装置,左右、上下椎弓根螺钉分别在水平面和矢状面以较大成角置入螺钉等方法提高螺钉固定相对稳定性;对15例Ⅱ级和Ⅲ级骨质疏松患者,钉道注入骨水泥以提高螺钉固定绝对稳定性。结果与结论:随访9-26个月,平均14个月,无螺钉断裂,骨折组仅2例JikeiⅠ级患者固定后五六个月时发生螺钉松动、部分复位矫正丢失等固定不稳,但无明显其他不良影响。骨折组复位矫正丢失平均5%,融合组植骨融合率100%。对于骨质疏松患者,根据骨质梳松程度采用不同的提高螺钉固定稳定性方法,可以减少螺钉松动和复位矫正丢失等固定不稳并发症。

BACKGROUND： Screw loosening and loss of correction are main complications in patients with osteoporosis receiving pedicle screw implantation. Therefore, osteoporosis is considered as a relative contraindication for pedicle screws.OBJECTIVE： To study the clinical results of methods for improving stability of pedicle screw in patients with osteoporosis.METHODS： Thirty-four patients with osteoporosis were treated with pedicle screw internal fixation, and the methods of improving stability of pedicle screw were applied during the operation. There were 14 cases of fractures （fracture group） and 20 cases of osteopathy. Spinal posterolateral or intervertebral body graft fusion was performed in the 20 cases of osteopathy and five cases of fractures （fusion group）. According to Jikei grading scale for osteoporosis, eight cases were in early stage, 11 cases Ⅰ stage, eight cases Ⅱ stage and seven cases Ⅲ stage. For 19 cases inearly stage and Ⅰ stage osteoporosis, longer and large size of pedicle screws were used, combined with rod system with ankylosing connection between screws and connecting rods using two cross-link devices, placement of pedicle screw with large angles in the horizontal and the sagittal planes were applied to improve the relative stability of screw. For 15 cases of Ⅱ stage and Ⅲ stage osteoporosis, bone cement was used to fill the screw path to improve the absolute stability of screw. RESULTS AND CONCLUSION： There was no breakage of screw during the follow-up with the mean period of 14 months （ranged 9-26 months）, only two cases in fracture group with Jikei Ⅰ stage osteoporosis had screw loosening at 5 to 6 months after fixation, as well as partial loss of correction of reduction, but no other adverse effects. The loss of correction of reduction in the fracture group was 5% in average, and the fusion rate was 100% in the fusion group. Different methods of improving the stability of pedicle screw applied in patients with osteoporosis according to different situations may reduce the occurrence of complications, such as screw loosening and loss of correction.