PMMA增强的多孔中空椎弓根螺钉治疗腰椎退变性疾病的疗效和安全性

Clinical outcome and safety of cannulated pedicle screw with polymethylmethacrylate augmentation for degenerative lumbar diseases

中文关键词:  骨水泥  椎弓根螺钉  退变性腰椎疾病  骨质疏松

英文关键词:PMMA  Cannulated cemented pedicle screw  Degenerative lumbar diseases  Osteoporosis

中文摘要:

  【摘要】 目的：通过与传统骨水泥（PMMA）增强椎弓根螺钉固定方法的对比，分析使用PMMA增强的多孔中空椎弓根螺钉治疗退变性腰椎疾病的临床疗效及安全性。方法：2010年3月～2011年6月间在我科接受腰椎手术治疗的骨质疏松患者45例，其中24例患者采用传统的骨水泥增强椎弓根螺钉固定（对照组），平均年龄71.2岁（59～86岁），平均骨密度为0.60±0.16g/cm2；21例采用骨水泥增强的多孔中空椎弓根螺钉（TangoRS系统）固定（观察组），平均年龄72.0岁（58～87岁），平均骨密度0.57±0.24g/cm2。应用术前及术后ODI及JOA评分对比评价两组患者的临床效果；应用术后CT及X线评价椎体的融合融合情况及螺钉位置；通过统计术后并发症评价安全性。结果：两组患者均顺利完成手术，对照组患者平均手术时间158±43min，术中出血量233±23ml，平均住院时间12.3±4.6天；观察组患者平均手术时间146±34min，术中出血量225±36ml，平均住院时间13.2±6.5d；两组患者平均手术时间、术中出血量及平均住院时间比较，差异无统计学意义（P＞0.05）。对照组患者平均随访20.5个月，有3例患者PMMA渗漏至椎管内，1例PMMA由于椎体前壁破裂而穿出椎体前壁，未出现相应的神经并发症。有2例患者出现螺钉松动且未形成融合。观察组平均随访18.4个月，有1例患者PMMA渗漏至椎体前侧方，1例患者PMMA渗漏至椎管内，均未出现相应的神经并发症。对照组患者JOA评分术前为10.21±2.27分、术后为21.32±2.80分，ODI评分术前为47.34±6.30分、术后为18.47±4.89分；观察组患者JOA评分术前为10.12±2.64分、术后为21.83±2.43分，ODI评分术前为48.07±5.06分、术后为17.67±3.64，两组患者术前、术后JOA及ODI评分，组间对比无显著差异（P＞0.05），组内术后术前对比有显著差异（P＜0.05），两种方法均取得良好的效果。结论：采用PMMA增强的多孔中空椎弓根螺钉固定治疗骨质疏松退变性腰椎疾病与传统的骨水泥加强方式同样有较好的临床效果，安全性好，且采用注射的方式操作更为简单方便。

英文摘要:

  【Abstract】 Objectives: To compare the clinical outcomes between polymethylmethacrylate(PMMA) augmented cannulated pedicle screw and conventional screw plus PMMA augmentation for degenerative and osteoporotic lumbar diseases. Methods: 48 patients with degenerative lumbar diseases and osteoporosis during 2009 and 2011 were analyzed retrospectively, including 27 patients(average age 71.2, average bone density 0.60±0.16g/cm2) undergoing conventional screwand 21 patients(average 72.0, average bone density 0.57±0.24g/cm2) undergoing cannulated pedicle screw. The clinical outcomes were compared by using the Oswestry disability index scores(ODI) and Japanese Orthopaedic Association scores(JOA). The fusion status and the position of screw were observed by computed tomography(CT) and digital radiography(DR). Results: In conventional screw group, the average operation time was 158±43min, the average blood loss was 233±23ml, and the average hospital stay was 12.3±4.6d. While in cannulated pedicle screw group, the average operation time was 146±34min, average blood loss was 225±36ml, and the average hospital stay was 13.2±6.5d, which showed no statistical differences between 2 groups(P＞0.05). In conventional screw group which was followed up for 20.5 months, PMMA leakage to the spinal canal was observed in 3 patients, and PMMA broke through of the anterior wall due to anterior wall fracture in one patient, all had no neurological complications; screw loosening and bony nonunion were observed in 2 patients. In cannulated pedicle screw group which was followed up for 18.4 months, PMMA leakage to the lateral side of vertebral body and leakage into the spinal canal was observed in one patient respectively, but no neurological complications were found. In conventional screw group, JOA score before operation was 10.21±2.27 and 21.32±2.80 after operation, ODI before and after operation was 47.34±6.30 and 18.47±4.89 respectively. In cannulated pedicle screw group, JOA before operation and after operation was 10.12±2.64 and 21.83±2.43, ODI before operation and after operation was 48.07±5.06 and 17.67±3.64, which showed no statistical differences between 2 groups(P＞0.05). While there were significant differences of JOA and ODI score between pre and post operation in two groups(P＜0.05). Conclusions: There is good clinical efficacy of using PMMA augmentation of a cannulated pedicle screw as the same of PMMA augmentation of conventional screw, which also has good safety and simple operation.