空心带侧孔椎弓根螺钉灌注骨水泥强化内固定治疗老年腰椎退变性疾病的疗效观察

Observation of curative effect by hollow side-hole pedicle screw with bone cement infusion enhanced internal fixation in the treatment of senile lumbar degenerative diseases

目的 探讨应用空心带侧孔椎弓根螺钉灌注骨水泥强化内固定治疗老年腰椎退变性疾病的疗效。方法 34例老年腰椎退变性疾病患者,椎管减压后采用骨水泥强化空心带侧孔椎弓根螺钉系统进行内固定治疗。分别对患者术前和随访时的神经功能和生活能力进行评估。结果 本组患者共使用空心带侧孔椎弓根螺钉214枚,每个螺钉注入骨水泥量为1.2-2.0 ml,平均注入骨水泥1.5 ml,术中无骨水泥渗漏,术后复查影像学资料,骨水泥填充良好,无渗漏。患者术后随访13-38个月,平均随访20个月。34例患者术后1年复查均骨性融合,内固定物无松动。患者术前1 d、术后7 d、术后3个月视觉模拟评分法（VAS）评分为（7.00±1.19）、（3.52±0.47）、（3.34±0.48）分,Oswestry功能障碍评分（ODI）评分为（0.68±0.21）、（0.31±0.05）、（0.28±0.09）分。术后7 d患者的VAS评分及ODI评分与术前1 d比较,差异有统计学意义（P〈0.05）;术后3个月与术后7 d VAS评分及ODI评分比较,差异无统计学意义（P〉0.05）。结论 对于伴骨质疏松症的老年腰椎退变性疾病患者,应用空心带侧孔椎弓根螺钉灌注骨水泥强化内固定,能增强椎弓根螺钉的稳定性,防止螺钉的松动、拔出或脱位,有助于临床疗效的改善和保持。

Objective To investigate curative effect by hollow side-hole pedicle screw with bone cement infusion enhanced internal fixation in the treatment of senile lumbar degenerative diseases. Methods A total of 34 senile patients with lumbar degenerative diseases received hollow side-hole pedicle screw with bone cement infusion enhanced internal fixation for treatment after spinal canal decompression. Evaluation was made respectively on neurological function and activities of daily living before operation and during follow-up. Results All patients received totally 214 hollow side-hole pedicle screws, and each screw had infused bone cement as 1.2-2.0 ml, with mean content as 1.5 ml. There was no case with intraoperative bone cement leakage. Postoperative reexamination of imaging data showed good bone cement packing without leakage. Postoperative follow-up lasting 13-38 months, with mean follow-up time as 20 months. All 34 cases received examination after 1 year of operation, which showed synostosis in all cases without loosen internal fixation. The patients had visual analogue scale （VAS） scores respectively as （7.00 ± 1.19）, （3.52 ± 0.47） and （3.34 ± 0.48） points in 1 d before operation, 7 d and 3 months after operation, and they had Oswestry disability index （ODI） scores as （0.68 ± 0.21）, （0.31 ± 0.05） and （0.28 ± 0.09） points. The difference of VAS score and ODI score before operation and in 7 d after operation had statistical significance （P〈0.05）. There was no statistically significant difference of VAS score and ODI score between 3 months and 7 d after operation （P〉0.05）. Conclusion Implement of hollow side- hole pedicle screw with bone cement infusion enhanced internal fixation for senile lumbar degenerative diseases patients can enhance stability of pedicle screw and avoid loosen or dislocated screw. This method is helpful for improvement and maintenance of clinical effect.