骨水泥钉道强化椎体对退行性腰椎侧弯椎间融合器沉降及融合的影响

Effect of reinforcement of the vertebral body with cemented nail paths on interbody fusion and settlement in patients with degenerative scoliosis

目的探讨骨水泥钉道强化椎体对合并骨质疏松的退行性腰椎侧弯患者术后椎间融合器沉降及融合的影响。方法回顾性分析2020年1月至2023年6月收治的退行性腰椎侧弯患者24例,按手术方式分为A组(前外侧入路腰椎融合术联合后路经皮椎弓根螺钉内固定,16例)和B组(前外侧入路腰椎融合术联合后路经皮椎弓根螺钉内固定并加行骨水泥强化,8例),观察两组患者术中终板损伤、术后融合器沉降及融合、螺钉松动等情况,评估手术前后疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)。结果两组患者术后VAS评分、ODI指数明显下降,且较术前差异具有统计学意义(P<0.05)。B组术中终板损伤发生率、融合器融合率及沉降率、螺钉松动发生率较A组下降,但差异不具有统计学意义(P>0.05)。结论骨水泥钉道强化不仅可以增强椎弓根螺钉的把持力及抗拔出能力,同时可以增强椎体强度,可能对降低融合器沉降及融合有积极作用。

Objective To investigate the effect of cemented nail path reinforcement of the vertebral body on postoperative interbody fusion settling and fusion in patients with degenerative lumbar scoliosis combined with osteoporosis.Methods Twenty-four patients with degenerative lumbar scoliosis admitted from January 2020 to June 2023 were retrospectively analyzed and divided into Group A(anterolateral approach lumbar fusion combined with posterior percutaneous pedicle screw internal fixation)and Group B(anterolateral approach lumbar fusion combined with posterior percutaneous pedicle screw internal fixation and addition of cemented reinforcement)according to the surgical methods used.The two groups were observed to determine the intraoperative end-plate injury depending on the postoperative fusion device.The patients in both groups were observed for intraoperative endplate injury,postoperative fusion settling and fusion,and screw loosening.The visual analog score(VAS)of pain and the Oswestry dysfunction index(ODI)were evaluated before and after the operation.Results Postoperative VAS scores and ODI indices decreased significantly in both groups,and the difference was statistically significant compared to the preoperative period(P<0.05).The incidence of intraoperative endplate injury,the fusion rate and settlement rate of the fusion device,and the incidence of screw loosening decreased in group B compared to group A,but the difference was not statistically significant(P>0.05).Conclusion The reinforcement provided by a bone-cemented nail channel not only enhanced the holding power and anti-extraction ability of pedicle screws,but also strengthened the vertebral body,which may have a positive effect on reducing settling and fusion of the fusion device and deserves wide clinical use.