普通椎弓根螺钉与骨水泥型椎弓根螺钉在骨质疏松脊柱手术中的比较研究

Traditional pedicle screws versus cement-augmented pedicle screws in osteoporotic spine surgery: a comparative clinical study

目的分析总结普通椎弓根螺钉与骨水泥型椎弓根螺钉在骨质疏松患者脊柱手术中的临床应用情况,综合评价新型骨水泥型椎弓根螺钉的安全性及可靠性。方法 2009年1月至2013年5月,对227例合并骨质疏松的胸腰椎疾病患者进行后路椎板切除减压椎体间融合术,其中普通椎弓根螺钉组151例,男86例,女65例,平均年龄(71.4±6.7)岁;新型骨水泥型椎弓根螺钉组76例,男42例,女34例,平均年龄(73.1±7.0)岁。比较两组患者在手术时间、出血量、术后12个月疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)以及螺钉松动率、椎间融合情况。结果骨水泥型椎弓根螺钉组无螺钉松动、断裂,所有病例获得椎体间植骨愈合;术后12个月的VAS和ODI评分分别为(2.0±0.5)分和(24.0±4.5),明显优于普通螺钉组的(1.7±0.5)分和(21.7±5.0),差异有统计学意义(P<0.05);普通椎弓根螺钉组出现26枚螺钉松动,松动率为3.3%。结论在骨质疏松腰椎内固定手术中,新型骨水泥型椎弓根螺钉较普通椎弓根螺钉具有更低的螺钉松动率,无骨水泥椎管内渗漏并发症,临床安全性高,近期效果满意,为骨质疏松患者手术提供了一种新型、可靠的内固定选择。

Objective To analyze clinical applications of traditional pedicle screws and cement-augmented pedicle screws in osteoporotic spine surgery, and to evaluate the safety and feasibility of novel cement-augmented pedicle screws. Methods From January, 2009 to May 2013, 227 cases of thoracolumbar spine diseases combined with osteoporosis were enrolled and underwent posterior laminectomy decompression and lumbar interbody fusion. One hundred and fifty-one cases received traditional pedicle screws（ 86 males, 65 females, the mean age： 71.4± 6.7 years）. Seventy-six cases received cement-augmented pedicle screws（ 42 males, 34 females, the mean age： 73.1± 7.0 years）. Operation time and blood loss volume in 2 groups were recorded. Visual analogue scale（ VAS）, Oswestry disability index（ ODI）, rate of screw loosening and fusion conditions were compared 12 months postoperatively. Results In cement-augmented pedicle screw group, all patients achieved spinal fusion without any screw loosening or breakage. VAS score and ODI score were 2.0±0.5 and 24.0±4.5 12 months postoperatively, which were significant superior to those in traditional pedicle screw group（ VAS score and ODI score： 1.7±0.5 and 21.7±5.0） with statistical significance（ P〈0.05）. In contrast, 26 traditional pedicle screws loosened with a loosening rate of 3.3%. ConclusionsIn osteoporotic spine operation, cement-augmented screws can provide excellent fixation stability as well as safety, with lower incidence rate of loosening and spinal canal leakage. It provides a novel fixation method for osteoporotic spinal surgery.