使用PMMA增强的多孔中空椎弓根螺钉治疗退变性腰椎疾病

Cannulated cemented pedicle screw instrumentation with polymethylmethacrylate augmentation in the treatment of degenerative lumbar diseases with osteoporosis

[目的]观察使用PMMA增强的多孔中空椎弓根螺钉治疗退变性腰椎疾病的临床效果及安全性。[方法]2010年3月～2011年5月间，34例伴有骨质疏松的退变性腰椎疾病患者接受了腰椎减压融合手术，采用PMMA增强的多孔中空椎弓根螺钉固定，通过术前及术后腰椎JOA评分的变化评价临床效果，通过术后CT及X线评价椎体融合率及螺钉位置，通过统计术后并发症的发生率评价安全性。[结果]34例患者中，男性10例、女性24例；平均年龄69．5岁（58～87岁），平均骨密度（0．52±0．14）g／cm^2，平均随访时间18．4个月（13～27个月），有效骨水泥注射量为（1．44±0．12）ml。未出现椎弓根穿破椎弓根侧壁及前壁，有1例患者PMMA渗漏至椎管，1例渗漏至椎体前侧方，均未出现相应并发症。1例出现螺钉切割松动伴固定节段椎体再骨折。总的融合率为91．4％（32／35节段）。3枚椎弓根螺钉出现骨-水泥界面松动，根据腰椎JOA评分表，治疗改善率达到：优7例，良18例，中8例，差1例。[结论]采用PMMA增强的多孔椎弓根螺钉治疗骨质疏松性退变性腰椎疾病有较好的临床及影像学效果，置钉安全、有效。

[ Objective] To determine the efficacy, radiological findings, clinical outcomes and complications in patients with degenerative lumbar diseases and osteoporosis after the use of polymethylmethacrylate （PMMA） augmentation of a cannulated pedicle screw. [ Methods] Thirty - four patients with degenerative lumbar diseases and osteoporosis （ T - score 〈 - 2. 5 ） underwent lumbar fusion using cannulated cemented pedicle screw instrumentation with polymethylmethacrylate augmentation between marth 2010 and may 2011. The clinical outcomes were evaluated by using the visual analog scale （VAS） and the lumbar JOA score. Radiologic findings were documented through computed tomography （CT） and plain films. [ Results ] There were 10 males and 24 females with average age of 69. 5 year old （range from 58 to 87） and average follow up of 18.4 month （range from 13 month to 27 month） . The average bone mineral density （BMD） was （0. 52 ±0. 14） g/cm2. The effective volume of polymethylmethacrylate injected in the vertebral body was （1.44 ±0. 12） ml. No pedicle screw was found breaking the front and side wall of the vertebral body. The polymethylmethacrylate was found leakage into the spinal canal in one patient and to the outside of the vertebral column in another patient without any abnormal nervous symptoms. Pedicle screw cut - out was found in one patient with refracture of the fixation segment. According to the JOA score, 7, 18, 8 and 1 patients were in excellent, good, fair and poor treament improvement rate. [ Conclusion] The results show favorable outcome both clinically and radiographically. Based on the results, the use of this surgical method can be a safe and effective option for the operation on the osteoporotic degenerative lumbar diseases.