骨水泥钉道强化联合空心侧孔椎弓根螺钉治疗伴骨质疏松症的腰椎退行性病变的临床疗效观察

Comparison of the clinical effect of PMMA bone cement augmented screw passageway and bone cement - injectable cannulated pedicle screw in treatment of degenerative lumbar disease with osteoporosis

目的比较空心侧孔椎弓根螺钉和骨水泥钉道（PMMA）强化方法应用于伴骨质疏松症的腰椎退行性病变的临床效果。方法选取伴骨质疏松症的腰椎退行性病变患者48例，男21例，女27例；年龄54～78岁，平均64．5岁。其中腰椎管狭窄症17例，腰椎间盘突出症18例，退行性腰椎滑脱症8例，腰椎退行性侧凸5例。按手术方式分为两组，A组23例采用空心侧孔椎弓根螺钉＋PMMA。B组25例采用PMMA行钉道强化＋普通椎弓根螺钉内固定术。比较两组手术时间、出血量、住院时间。采用疼痛视觉模拟量表（visualanaloguescale，VAS）评分，Oswestry功能障碍指数（Oswestry disability index，ODI）评价患者术后疼痛和功能恢复情况。术前及术后1、3、6、12个月及术后每年行X线检查评估椎间隙高度丢失、内固定失败率和椎间植骨融合率。结果48例患者均得到随访，随访时间1—3．5年。A组手术时间、出血量、住院时间显著优于B组（均P〈0．05）。A组、B组植骨融合率分别为92．1％、91．2％，两组差异无统计学意义（P〉0．05）。A组发生螺钉断裂1例，B组未出现此类情况（P〈0．05）。B组发生内固定松动、螺钉拔出内固定失败1例，A组未发生此类情况（P〈0．05）。A组椎间隙高度丢失（2．7±1．7）mm，B组椎间隙高度丢失（3．7±2．1）mm，两组差异有统计学意义（P〈0．05）。根据VAS评分和ODI，两组患者术后疼痛与功能均得到改善，A组效果优于B组（均P〈0．05）。结论空心侧孔椎弓根螺钉＋PMMA强化内固定用于伴骨质疏松症的腰椎退行性病变是一种具有较好安全性和有效性的方法。

Objective To compare the clinical effect of PMMA bone cement augmented screw passageway and bone cement - injectable cannulated pedicle screw in treatment of degenerative lumbar disease with osteoporosis. Methods Forty -eight patients with lumbar degenerative disease accompanied with osteoporosis from June 2012 to March 2014 were selected, including 21 males and 27 females with an average age of 64.5 years （ranged 54 - 78 years）. There were 17 cases of lumbar degenerative stenosis, 18 cases of lumbar intervertebral disc herniation, 8 cases of lumbar degenerative spondylolisthesis, and 5 cases of lumbar degenerative scoliosis. According to the operation method,the patients were divided into two groups. 23 cases in group A were treated with bone cement injectable cannulated pedicle screw and 25 cases in group B were treated with PMMA bone cement augmented screw passageway by used conventional screw. Operation time, amount of bleeding and hospitalization time were used to evaluate the clinical characteristics. Visual analogue scale（VAS） score and Oswestry disability index（ODI） were used to evaluate function recovery of post- operative pain and function. The height of intervertebral space,failure rate of internal fixation and bone fusion rate were analyzed by X - ray films postoperativel, 3,6,12 months and per year. Results All 48 cases were followed up for 1 - 3.5 years. Operation time, amount of bleeding and the time of hospitalization of group A were significantly lower than those in group B （ all P 〈 0.05）. The fusion rates of group A and group B were 94. 6% and 90.2%, respectively. There was no significant difference between the two groups （P 〉 0.05 ）. One case of group A had screw fracture,but group B did not appear this kind of situation（P 〈0.05）. Three cases of group B had screw loosening or pullout, but that did not happen in group A. The loss of intervertebral height was （2.7 ±1.7） mm in group A, which in group B was （ 3.7±2.1 ） mm, there was significant difference between the two groups （ P 〈 0. 05）. According to VAS score and ODI, pain and function in both two groups were improved, but the effect of group A was better than group B （ all P 〈 0.05 ）. Conclusion Bone cement - augmentation bone cementinje - ctable cannulated pedicle screw may be a safe and effective method in treatment of degenerative lumbar disease with osteoporosis.