膨胀式椎弓根螺钉在骨质疏松患者腰椎短节段固定融合手术中的临床应用

The clinical application of expandable pedicle screws in the short segment lumber fusion surgery in osteoporosis patients

中文关键词:  骨质疏松症  腰椎融合术  椎弓根螺钉

英文关键词:Osteoporosis  Posterior lumbar interbody fusion  Pedicle screws

中文摘要:

  【摘要】 目的：分析膨胀式椎弓根螺钉在骨质疏松患者腰椎短节段固定融合手术中应用的中期疗效。方法：回顾性分析2007年1月~2013年7月行腰椎后路固定融合术且获得3年以上随访资料的患者406例，其中男147例，女259例，年龄50~79岁（63.4±4.2岁），术前腰椎骨密度T值为-3.3±0.6（-2.5～-4.6）。根据术中使用椎弓根螺钉种类的不同，分为膨胀式椎弓根螺钉（EPS）组（n=173）和普通椎弓根螺钉（CPS）组（n=233）。两组患者的性别构成、术前骨密度T值、疾病类型、随访时间均无统计学差异（P＞0.05）。术前、术后3个月、术后6个月及末次随访时采用VAS和Oswestry功能障碍指数（Oswestry disability index，ODI）进行评价。根据术后每次随访时拍摄的X线片或CT情况，比较两组患者的脊柱融合率、螺钉松动率及断钉情况。结果：所有患者随访时间为3~8年（3.7±1.0年）。两组患者术前VAS评分和ODI评分均无统计学差异（P＞0.05）；两组术后3个月、6个月和末次随访时的VAS评分和ODI评分均较术前显著改善（P＜0.05）；术后3个月、6个月和末次随访时，EPS组患者VAS评分及ODI评分均明显低于CPS组（P＜0.05）。EPS组中，1例（0.6%，1/173）患者的2枚（0.3%，2/796）螺钉出现松动，5例（2.9%，5/173）患者的7枚（0.9%，7/796）螺钉出现断裂；CPS组中，13例（5.6%，13/233）患者的17枚（1.8%，17/960）螺钉出现松动，2例（0.9%，2/233）患者的4枚（0.4%，4/960）螺钉出现断裂。EPS组螺钉松动率显著低于CPS组（P＜0.05），螺钉断裂率与CPS组比较无统计学差异（P＞0.05）。EPS组融合成功率（99.4%，172/173）显著高于CPS组（93.6%，218/233）（P＜0.05）。结论：在骨质疏松患者腰椎短节段固定融合手术中，使用膨胀式椎弓根螺钉相比普通椎弓根螺钉具有更低的螺钉松动率和更高的脊柱融合率，是一种安全可靠的手术方案。

英文摘要:

  【Abstract】 Objectives: A retrospective analysis on the mid-term clinical effect of expandable pedicle screws in the short segment lumber fusion surgery in osteoporosis patients. Methods: From January 2007 to July 2013, 406 patients treated with standard posterior lumbar interbody fusion(PLIF) were reviewed retrospectively. All patients were followed up for a minimum of 3 years. Among the 406 cases, 147 were males and 259 were females with an overall mean age of 63.4±5.2 years(range, 50-79 years). The T value of pre-operative lumbar BMD was -3.3±0.6(2.5-4.6). Among these patients, 173 patients received PLIF with expandable pedicle screws(EPS group) and the other 223 patients received PLIF with conventional pedicle screws(CPS group). No significant difference was detected between the two groups on gender composition, T value of pre-operative BMD, disease composition and the time of last follow-up visit(P＞0.05). The pre-operative and post-operative(3 months, 6 months and last follow-up) visual analogue scores(VAS) and Oswestry disability index(ODI) scores were compared to evaluate the function recoverly conditions. X-ray or CT scan was taken to compare the screw loosening rate, breakage rate and fusion rate between the two groups. Results: The average follow-up period was 3.7±1.0 years(range, 3-8 years). No significant difference was detected between the two groups on pre-operative VAS and ODI scores(P＞0.05). After surgeries, VAS and ODI scores at 3 months, 6 months and last follow-up improved significantly in both groups. Compared with CPS group, post-operative VAS and ODI scores at 3 months, 6 months and last follow-up in the EPS group improved significantly(P＜0.05). In EPS group, 2 screws loosening(0.3%, 2/796) occurred in 1 patient(0.6%, 1/173), and 7 screws breakage(0.9%, 7/796) occurred in 5 patients(2.9%, 5/173). In the CPS group, 17 screws loosening(1.8%, 17/960) occurred in 13 patients(5.6%, 13/233), and 4 screws breakage(0.4%, 4/960) occurred in 2 patients(0.9%, 2/233). The screw loosening rate in EPS group was significantly lower than that in CPS group(P＜0.05). The screw breakage rate was higher than that in CPS group, but there was no significant difference(P＞0.05). The fusion rate in EPS group(99.4%, 172/173) was significantly higher than that in CPS group(93.6%, 218/233)(P＜0.05). Conclusions: In the short segment lumbar fusion surgery in osteoporosis patients, the application of expandable pedicle screws can provide lower screw loosening rate and higher fusion rate. It is a safe and reliable implant for osteoporotic spinal surgery.