S1螺钉骨水泥强化技术在伴骨质疏松腰骶椎退变性疾病中的应用价值

Cement-augmented sacral screw in lumbosacral degenerative disease with osteoporosis

中文关键词:  骶1螺钉  骨水泥强化  骨质疏松  腰骶椎退变性疾病

英文关键词:Sacral screw  Cement augmentation  Osteoporosis  Lumbosacral degenerative disease

中文摘要:

  【摘要】 目的：探讨S1螺钉骨水泥强化技术在伴骨质疏松腰骶椎退变性疾病中的应用价值。方法：回顾性分析2012年5月～2015年12月采用后路腰骶椎固定治疗的患者61例，男6例，女55例，年龄67.5±6.6岁（60～86岁），骨密度T=-3.37±0.69 SD（-2.5～-5.4 SD），随访时间19.98±10.42个月（24～78个月），腰椎采用椎弓根螺钉骨水泥强化技术，根据S1螺钉的固定方式将患者分为骨水泥强化组（A组，17例）、双皮质固定组（B组，20例）和三皮质固定组（C组，24例），比较三组在视觉模拟评分（visual analog scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）评分和围手术期并发症、松钉率、融合率等方面的差异。结果：所有患者均顺利完成手术，在VAS和ODI方面，三组患者末次随访评分均较术前明显改善，末次随访时A组VAS和ODI明显小于B组和C组，差异具有统计学意义（P<0.05），B、C两组相比无明显差异。在并发症方面，A组腰椎骨水泥渗漏率为23.68%，S1骨水泥渗漏率为23.53%，分别有1例患者出现硬膜囊撕裂、切口感染和双下肢肌力下降，没有患者发生螺钉松动断裂，末次随访时所有手术节段均获骨性融合；B组骨水泥渗漏率为41.25%，2例患者发生健侧下肢麻木乏力，6例患者出现S1螺钉松动（30.00%）；C组骨水泥渗漏率为24.56%，2例患者出现硬膜囊撕裂，1例发生切口感染，1例发生健侧下肢麻木乏力，6例患者出现S1螺钉松动（25.00%）。将B、C两组患者分为松钉组和未松钉组，发现其在年龄、融合节段、术后PI-LL上具有统计学差异（松钉组年龄更大、融合节段更长，术后PI-LL更大），在性别、BMD、BMI、手术方式、术前术后LL、SS、PT、PI、LL差值、术前PI-LL等方面无统计学差异（P>0.05）。结论：S1螺钉骨水泥强化技术能明显减少伴骨质疏松患者腰骶固定的松钉率，是骨质疏松性腰骶椎退变性疾病的一种有效固定方式，尤其适用于老年、≥2节段固定和PI-LL恢复不佳的患者。

英文摘要:

  【Abstract】 Objectives: To evaluate the outcomes of cement-augmented sacral screw in lumbosacral degenerative disease with osteoporosis. Methods: From May 2012 to December 2015, 61 patients with bone mineral density T score of -3.37±0.69 SD(-2.5 to -5.4 SD), who underwent posterior lumbosacral fixation with pedicle screws were enrolled, including six males and fifty-five females, aging from 60-80 years(67.5±6.6 years) old. All patients received cement-augmented pedicle screw fixation at L5, and they were divided into 3 groups according to fixation patterns of S1 pedicle screws, bone cement augmentation group(group A, 17 cases), bicortical pedicle screw group(group B, 20 cases) and three cortical pedicle screw group(group C, 24 cases). The visual analogue scale(VAS) and Oswestry disability index(ODI) before surgery and at the final follow-up were assessed. Besides, the operative complication, screw loosening rate and bone fusion rate were also recorded. Results: All the surgeries were successful, and patients were followed up for 19.98±10.42 months(24-78 months). The VAS and ODI scores at the final follow-up significantly improved from the scores before surgery in all groups. In addition, group A had the lowest VAS and ODI scores at final follow-up when compared to the other two groups, and no significant difference was detected between group B and C(P＞0.05). In group A, the rate of bone cement leakage in lumbar and sacrum was 23.68% and 23.53%, respectively, other complications included dural tear(1 case), shallow wound infection(1 case) and lateral plantar flexion weakness(1 case), with no screw loosening and fusion failure. In group B, the rate of bone cement leakage was 41.25%, the rate of S1 screw loosening was 30%, with 2 cases of contralateral limb numbness and weakness. In group C, the rate of bone cement leakage was 24.46%, the rate of S1 screw loosening was 25%, with 2 cases of dural tear, 1 case of wound infection, 1 case of contralateral limb numbness and weakness. Furthermore, old age, long fusion segment and large post-op PI-LL were found as the risk factors of S1 screw loosening without cement-augmentation, rather than gender, BMD, BMI, surgical approach, pre and post-operative LL, SS, PT, PI, or the change of LL, pre-operative PI-LL(P>0.05). Conclusions: Sacral screw cement augmentation is able to achieve optimistic stability with less screw loosening in lumbosacral degenerative disease with osteoporosis, which is especially recommended in patients with old age, two or more segments fixation and large post-operation PI-LL.