骨水泥强化与常规椎弓根螺钉固定治疗老年退行性腰椎疾病的比较

Comparison of bone cement augmented with traditional pedicle screw in the treatment of degenerative lumbar disease

目的比较骨水泥强化与常规椎弓根螺钉固定治疗老年退行性腰椎疾病的疗效。方法回顾性分析2013年5月至2015年5月采用腰椎融合术治疗40例老年退行性腰椎疾病患者资料，根据置入椎弓根螺钉的椎体内是否注入骨水泥分为常规组（未置入骨水泥，20例，男5例，女15例；年龄平均73．2岁；腰椎间盘突出12例，腰椎管狭窄8例）和骨水泥强化组（置入骨水泥，20例，男6例，女14例；年龄平均73．7岁；腰椎间盘突出12例，腰椎管狭窄8例），螺钉分别置入L3、L4、L5及S1共170个椎体。分别评估术前、术后30天及末次随访的Oswestry功能障碍指数、固定节段上位相邻椎间隙高度、固定节段上位相邻椎体变形指数、固定节段Cobb角、固定节段椎体上缘终板及相邻上位椎体下缘终板凹陷角度。结果40例患者经3～24个月随访，平均随访12．2个月。末次随访Oswestry功能障碍指数常规组及骨水泥强化组评分分别为13．0％±4．9％和11．0％±8．0％，两组比较差异无统计学意义。末次随访与术后30d的平均Cobb角的变化值常规组及骨水泥强化组分别为5．53°±1．64°、2．15°±0．97°。骨水泥强化组术后30d出现上终板凹陷角度增大，末次随访时相邻上位椎体下终板凹陷角度、椎体变形指数及相邻椎间隙均减小，且前两项指标的改变程度明显大于常规组。结论骨水泥强化与常规椎弓根螺钉固定均能缓解患者症状，但骨水泥强化椎弓根螺钉能明显提高老年患者内固定术后椎体的稳定性。

Objective To compare post-operative clinical outcomes between bone cement augmented pedicle screw and traditional pedicle screw in treatment of degenerative lumbar disease. Methods Data of 40 cases with lumbar degenerative dis- ease who had surgery from May 2013 to May 2015 were retrospectively analyzed. They were divided into two groups according to whether the bone cement was injected in the vertebral body with pedicle screw： conventional group and augmented group. There were 5 males and 15 females in conventional group with an average age of 73.2, among them there were 12 cases of lumbar disc prolapse and 8 cases of lumbar spinal stenosis. There were 6 males and 14 females with an average age of 73.7, among them there were 12 cases of lumbar disc prolapse and 8 cases of lumbar spinal stenosis. The screws were inserted into L3, L4, L5, and S1 with a total of 170 vertebral bodies. The Oswestry Disability Iindex （ODI）, intervertebral distance of the upper adjacent segments, defor- mation index of the upper adjacent vertebral body, Cobb angle, concave angle of the fixed lumbar vertebrae superior end-plate and the upper adjacent vertebral body inferior end-plate were measured pre-operation, 30 d postoperatively and at final follow-up. Re- sults 40 patients were followed-up for 3-24 months （average 12.2 months）. The ODI of traditional group and bone cement aug- mented group respectively was 13.0%±4.9% and 11.0%±8.0%, and there was no significant difference between two groups. The change of Cobb angle of fixed lumbar vertebrae at the final follow-up and 30 days postoperatively was 5.53°± 1.64°and 2.15°± 0.97°. The concave angle of upper end-plate was increased in bone cement augmented group at 30 days after operation compared with that in conventional group; the lower end-plate concave angle of adjacent centrum, the rectangular index and the adjacent in- tervertebral space of conventional pedicle screw with bone cement group was all decreased in the final follow-up, and the change of the first two indicators was significantly bigger than those in the conventional pedicle screw group. Conclusion Both groups can effectively treat the degenerative lumbar disease, but bone cement augmented pedicle screw can maintain the stability of the spine of aged patients better.