摘要
背景:老年腰椎退变患者在手术中常面临椎弓根螺钉把持力不足情况,易发生脱钉、固定不牢靠等风险,如何增加螺钉的把持力成为研究的热点。目的:探讨使用椎弓根螺钉骨水泥强化方案治疗老年腰椎退变的早期临床效果。方法:选择2012年8月至2014年4月收治的患腰椎退行性疾病行腰椎内固定治疗的患者65例,根据修复方案分为2组,椎弓根螺钉内固定骨水泥强化组24例,常规椎弓根螺钉内固定组41例。比较两组患者的一般情况,采用目测类比评分法和日本矫形科学学会腰椎功能评分表对患者腰背疼痛及下肢神经功能恢复情况进行评估。结果与结论:65例患者均完成手术,获得随访,随访时间为3-20个月,随访中均行腰椎正侧位片X射线片,未发现螺钉松动、脱落、断裂、椎间隙高度丢失等情况。椎弓根螺钉内固定骨水泥强化组患者的手术出血量、住院时间与常规椎弓根螺钉内固定组差异无显著性意义(P>0.05),椎弓根螺钉内固定骨水泥强化组术后3,6个月日本矫形科学学会腰椎功能评分及术后3个月的目测类比评分均较常规椎弓根螺钉内固定组显著改善(P<0.05);两组术后6个月的目测类比评分差异无显著性意义(P>0.05)。提示将骨水泥沿椎弓根螺钉钉道注入椎弓根及椎体,可达到螺钉骨水泥强化的目的,增加螺钉的把持力,重建腰椎的稳定性,取得了满意的近期疗效。
BACKGROUND：Elderly patients with degenerative lumbar degeneration often appear insufficient holding power of pedicle screw in spine surgery, which is prone to occur de-pinning and leads to insecure fixation. How to increase the holding power of screws has become a hot research. OBJECTIVE：To observe the early clinical effect of pedicle screws with cement augmentation for treating lumbar degenerative diseases in elderly patients. METHODS：A total of 65 old patients with lumbar degenerative diseases received a treatment between August 2012 and April 2014, and were divided into two groups according to the treatment strategy：treatment group （n=24;internal fixation of pedicle screws with cement augmentation） and control group （n=41;routine internal fixation of pedicle screws）. General conditions of patients in two groups were observed and compared. Visual analog scale （VAS） and Japanese Orthopaedic Association （JOA） score system were used for evaluating the lumbar and back pain, and restoration of neurological function in lower limbs respectively. RESULTS AND CONCLUSION：Al of the patients successful y received the surgery and then were fol owed up from 3 to 20 months. The anterioposterior and lateral X-ray film revealed no loosening, loss, fracture of the screws, and no loss of intervetebral space height was found. There was no significant difference in the blood loss and hospital stay between two groups （P〉0.05）. JOA at postoperative 3 and 6 months, and VAS score at postoperative 3 months were significantly improved after the treatment of pedicle screws with cement augmentation, when compared to control group （P〈0.05）. VAS scores showed no difference at 6 months postoperatively in two groups （P〉0.05）. Pedicle screws with cement augmentation for treating lumbar degenerative diseases have the advantages of improving the screws holding strength, reconstructing the stability of lumbar vertebra and obtaining clinical efficacy on degenerative spine.
出处
《中国组织工程研究》
CAS
CSCD
2014年第35期5666-5670,共5页
Chinese Journal of Tissue Engineering Research
