应用钉道骨水泥强化椎弓根螺钉技术治疗胸腰椎骨质疏松压缩性骨折伴后凸畸形的中远期疗效

The mid-term and long-term efficacy of cement augmentation of pedicle screws in the treatment of thoracolumbar osteoporotic vertebral compression fractures complicated with spinal kyphosis deformity

中文关键词:  脊柱  骨质疏松  后凸畸形  聚甲基丙烯酸甲酯  椎弓根螺钉

英文关键词:Spine  Osteoporosis  Kyphosis deformity  Polymethyl methacrylate  Pedicle screw

中文摘要:

  【摘要】 目的：评价应用钉道骨水泥强化椎弓根螺钉技术治疗胸腰椎骨质疏松椎体骨折伴后凸畸形的安全性和中期临床效果。方法：回顾性研究分析2017年1月~2020年10月收治的高龄骨质疏松椎体骨折伴后凸畸形患者的临床资料，根据是否使用骨水泥强化椎弓根螺钉技术分为强化组（椎弓根螺钉固定时采用钉道骨水泥强化，22例）、对照组（椎弓根螺钉固定时未采用骨水泥强化，23例）。强化组男9例，女13例；年龄70~91岁，平均78.68±7.12岁；病程1.1~3.8年，平均2.39±0.71年。对照组男10例，女13例；年龄70~89岁，平均77.73±5.83岁，病程0.8~3.3年，平均2.38±0.67年。随访36~69个月，比较末次随访时两组椎弓根螺钉松动发生率及脊柱后凸畸形矫正率、疼痛视觉模拟量表（visual analogue scale，VAS）评分和Oswestry功能障碍指数（Oswestry disability index，ODI）改善率。结果：强化组手术减压1~2个节段，固定融合6~9个节段，行SPO截骨14例、PSO截骨8例，手术时间221±32min，出血量939±113mL。对照组手术减压1~3个节段，固定融合6~8个节段，行SPO截骨16例、PSO截骨7例，手术时间209±36min，出血量979±111mL。强化组1例、对照组2例出现脑脊液漏，给予术中修补硬膜、严密缝合切口及术后头低脚高体位等处理。两组的减压节段（t=1.785，P=0.081）、融合节段（t=0.922，P=0.362）、手术时间（t=1.162，P=0.252）、出血量（t=1.193，P=0.239）及脑脊液渗漏并发症（χ2=0.311，P=0.577）对比均无统计学差异。无切口感染、骨水泥渗漏至椎管引起神经症状的并发症。末次随访时，螺钉松动率强化组0%（0/268），对照组18.6%（45/242），两组对比螺钉松动率差异有统计学意义（χ2=54.657，P=0.000）；后凸畸形矫正率强化组（73.27±9.78）%、对照组（55.96±11.31）%。两组后凸矫形率对比有显著差异性（t=5.480，P=0.000）；VAS改善率强化组（67.94±14.72）%、对照组（74.29±13.18）%，两组VAS改善率对比无显著差异性（t=1.526，P=0.134）；ODI改善率强化组（82.01±3.11）%、对照组（81.96±3.58）%，两组ODI功能评分改善率对比无显著差异性（t=0.41，P=0.968）。结论：应用钉道骨水泥强化椎弓根螺钉技术行减压截骨矫形长节段固定融合术治疗胸腰椎骨质疏松性椎体骨折伴后凸畸形，能够有效降低椎弓根螺钉松动率、提高矫形率，临床疗效满意。

英文摘要:

  【Abstract】 Objectives: To evaluate the safety and mid-term clinical efficacy of cement augmentation of pedicle screws in the treatment of thoracolumbar osteoporotic vertebral compression fractures complicated with spinal kyphosis deformity. Methods: A retrospective study was conducted to analyze the clinical data of elderly patients with osteoporotic vertebral compression fractures complicated with spinal kyphosis deformity admitted and treated from January of 2017 to October of 2020. According to whether pedicle augmentation using bone cement was used, the patients were divided into a cement-augmented group(22 cases, cement-augmented pedicle screws) and a control group(23 cases, pedicle screws without cement augmentation). In the reinforced group, there were 9 males and 13 females; age ranged from 70 to 91 years, with a mean of 78.68±7.12 years; disease duration ranged from 1.1 to 3.8 years, with a mean of 2.39±0.71 years. In the control group, there were 10 males and 13 females; age ranged from 70 to 89 years, with a mean of 77.73±5.83 years, and disease duration ranged from 0.8 to 3.3 years, with a mean of 2.38±0.67 years. The follow-up period was 36-69 months. The incidence of pedicle screw loosening, correction rate of kyphosis, and improvement rate of visual analogue scale(VAS) and Oswestry disability index(ODI) at final follow-up were compared between the two groups. Results: In the cement-augmented group, 1-2 segments of surgical decompression were performed, 6-9 segments were fixed and fused, and 14 cases underwent SPO and 8 cases underwent PSO. The operational time was 221±32mins, and the volume of blood loss was 939±113mL. In the control group, 1-3 segments of surgical decompression were performed, 6-8 segments were fixed and fused, and 16 cases underwent SPO and 7 cases underwent PSO. The operative time was 209±36mins, and the volume of blood loss was 979±111mL. One case in the cement-augmented group and two cases in the control group complicated with cerebrospinal fluid leakage, which were treated with intraoperative repair of the dura mater, tight suturing of the incision, and postoperative Trendelenburg′s position. There was no statistical difference in the comparison of decompression segments(t=1.785, P=0.081), fusion segments(t=0.922, P=0.362), operative time(t=1.162, P=0.252), bleeding(t=1.193, P=0.239), and CSF leak complications(χ2=0.311, P=0.577) between the two groups. There were no complications of incision infection or leakage of bone cement into the spinal canal causing neurological symptoms. At final follow-up, the screw loosening rate was 0% in the cement-augmented group(0/268) and 18.6% in the control group(45/242). The difference in screw loosening rate between the two groups was statistically significant(χ2=54.657, P=0.000). The correction rate of kyphosis deformity was (73.27±9.78)% in the cement-augmented group and (55.96±11.31)% in the control group. There was a significant difference in the correction rate of kyphosis between the two groups(t=5.480, P=0.000). The improvement rate of VAS in the cement-augmented group was (67.94±14.72)%, while in the control group was (74.29±13.18)%. There was no significant difference in the improvement rate of VAS between the two groups (t=1.526, P=0.134). The improvement rate of ODI in the cement-augmented group was (82.01±3.11)%, while in the control group it was (81.96±3.58)%, there was no significant difference in the improvement rate of ODI between the two groups(t=0.41, P=0.968). Conclusions: The application of cement augmentation of pedicle screws in decompression, osteotomy, and long segment fixation fusion for the treatment of thoracolumbar osteoporotic vertebral compression fractures with spinal kyphosis deformity can effectively reduce the loosening rate of pedicle screws and improve the correction rate, resulting in satisfactory clinical outcomes.