预防螺钉松动拔出及复位椎体再滑脱:如何更好的治疗骨质疏松性腰椎滑脱症

Preventing the screw from loosening and pulling out,secondary lumbar spondylolisthesis:how to select a better therapeutic scheme for osteoporotic lumbar spondylolisthesis?

背景:研究认为膨胀式椎弓根螺钉抗旋能力强,可以很好的预防螺钉松动、拔出,维持腰椎稳定性、保持其生理曲度,为远期椎体间融合提供一个安全稳定的环境。目的:探讨膨胀式椎弓根螺钉与普通椎弓根螺钉治疗骨质疏松性腰椎滑脱症的差异。方法:合并骨质疏松的腰椎滑脱症患者共67例分为保守组12例、膨胀式椎弓根螺钉组20例、普通椎弓根螺钉组35例。3组采集入院时、入院后1周、出院后6个月、出院后12个月、出院后24个月的目测类比评分和JOA评分及影像学资料,对螺钉稳定性、脊柱融合情况进行评估,参考Meyerding滑脱分级标准评估椎体的滑脱情况。结果与结论:(1)末次随访时JOA改善率:膨胀式椎弓根螺钉组与普通椎弓根螺钉组相比较差异无显著性意义(P=1.00),均显著高于保守组(P均<0.05);(2)目测类比评分:膨胀式椎弓根螺钉组与普通椎弓根螺钉组均显著降低,两组间比较差异无显著性意义(P>0.05),而保守治疗组目测类比评分时高时低,反复变化;(3)滑脱复位率:膨胀式椎弓根螺钉组明显高于普通椎弓根螺钉组(P<0.01);(4)内固定后24个月脊柱融合评分:膨胀式椎弓根螺钉组明显高于普通椎弓根螺钉组(P=0.035);(5)结果说明:对于合并骨质疏松的腰椎滑脱患者,采用膨胀式椎弓根螺钉固定在滑脱复位、植骨融合率、螺钉稳定性等方面都明显优于普通椎弓根螺钉,此方法更加安全有效。

BACKGROUND： Expansive pedicle screws have been found to have strong resistance to rotation, prevent screwloosening and pulling out, and maintain the stability and physiological curvature of lumbar vertebrae, so it provides asecure and stable environment for long-tem intervertebral fusion.OBJECTIVE： To investigate the clinical efficacy of the expandable versus conventional pedicle screws in the treatmentof osteoporotic lumbar spondylolisthesis.METHODS： A total of 67 cases of osteoporotic lumbar spondylolisthesis were randomized into three groups, and thentreated with conservative treatment （n=12）, expansive pedicle screws （n=20）, and common pedicle screws （n=35）,respectively. The Japanese Orthopaedic Association and Visual Analogue Scale scores as well as radiological data wereobtained immediately and 1 week after admission, 6 and 12 months after discharge. The stability of the screw and spinalfusion were evaluated, and the spondylolisthesis was assessed according to Meyerding system.RESULTS AND CONCLUSION： （1） The improvement rate of Japanese Orthopaedic Association scores at the lastfollow-up showed no significant difference between expansive and common groups （P=1.00）, and the improvement ratein the expansive and common groups was significantly higher than that in the conservative group （P 〈 0.05）. （2） TheVisual Analogue Scale scores in the expansive and common groups were significantly decreased, and the scores did notdiffer significantly between two groups （P 〉 0.05）; the scores in the conservative group changed irregularly. （3） Thereduction rate of spondylolisthesis in the expansive group was significantly higher than that in the common group （P 〈0.01）. （4） The spinal fusion score at 24 months postoperatively in the expansive group was significantly higher than thatin the common group （P=0.035）. （5） For osteoporotic patients with lumbar spondylolisthesis, the expansive pediclescrews are much better than the common pedicle screws in the spondylolisthesis reduction, fusion rate of bone graft,screw stability; therefore, it is a safer and more effective method.