中国组织工程研究

中国组织工程研究 ›› 2014, Vol. 18 ›› Issue (47): 7556-7560.doi: 10.3969/j.issn.2095-4344.2014.47.003

• 组织工程骨及软骨材料 tissue-engineered bone and cartilage materials • 上一篇    下一篇

骨水泥注入中空侧孔椎弓根螺钉内固定骨质疏松性腰椎退变：强化技术要点

荆丹峰，许艺荠，孙太存，田  进，鲁  彪，崔学文   

  1. 江苏大学附属医院骨科，江苏省镇江市  212001
  • 修回日期:2014-09-02 出版日期:2014-11-19 发布日期:2014-11-19
  • 通讯作者: 崔学文，博士，主任医师，硕士生导师，江苏大学附属医院骨科，江苏省镇江市 212001
  • 作者简介:荆丹峰，男，1981年生，江苏省镇江市人，汉族，江苏大学在读硕士，医师，主要从事脊柱方面的研究。
  • 基金资助:

    镇江市课题(SH2012026)，课题名称：纳米颗粒包载髓鞘相关抑制因子siRNA促进脊髓损伤神经轴突再生的临床应用

Polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw for lumbar degenerative disease accompanied with osteoporosis: strengthening technical points

Jing Dan-feng, Xu Yi-ji, Sun Tai-cun, Tian Jin, Lu Biao, Cui Xue-wen   

  1. Department of Orthopedics, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
  • Revised:2014-09-02 Online:2014-11-19 Published:2014-11-19
  • Contact: Cui Xue-wen, M.D., Chief physician, Master’s supervisor, Department of Orthopedics, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
  • About author:Jing Dan-feng, Studying for master’s degree, Physician, Department of Orthopedics, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
  • Supported by:

    the Project of Zhenjiang City, No. SH2012026

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摘要：

背景：腰椎退行性病变一旦合并腰椎管狭窄、腰椎失稳及退变性侧凸，引起相应的临床症状需要手术治疗时，不可避免的需要使用内固定器械。骨质疏松在老年人群中相当普遍，因此如何在严重骨质疏松患者的脊柱上置入稳定的椎弓根螺钉内固定系统将是一个很大的难题。近年来有研究证实了骨水泥强化中空侧孔椎弓根螺钉在椎体内的生物力学稳定性，因此成为脊柱外科的关注热点。
目的：探讨应用聚甲基丙烯酸甲酯骨水泥强化中空侧孔椎弓根螺钉置入内固定修复伴骨质疏松症的腰椎退变性疾病的疗效。
方法：2012年2月至2014年3月江苏大学附属医院骨科共收治伴骨质疏松症的腰椎退行性变患者31例，男11例，女20例；年龄65-86岁，平均73.5岁。其中腰椎管狭窄症14例，腰椎间盘突出症并节段不稳9例，退行性腰椎滑脱症6例，退行性侧凸2例。根据患者症状、体征及影像学资料确定减压、融合节段，采用骨水泥强化中空侧孔椎弓根螺钉系统进行内固定、矫形。采用目测类比评分法对患者内固定前后的疼痛状况进行评估，神经症状缓解情况采用日本骨科学会(JOA) 29分法对内固定前和随访时的神经功能和生活能力进行评估。
结果与结论：所有病例随访36-48个月，未出现断钉、断棒、椎弓根螺钉拔出、松动、融合节段假关节形成以及切口感染等并发症。内固定后患者腰痛、腿痛目测类比评分及神经症状JOA评分均明显改善(P < 0.01)。提示对于伴骨质疏松症的腰椎退行性变患者，应用骨水泥强化型中空侧孔椎弓根螺钉系统置入内固定，能增强螺钉的稳定性，防止螺钉松动、拔出，有助于临床疗效的改善和保持。


中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程


全文链接：

关键词: 生物材料, 骨生物材料, 中空侧孔椎弓根螺钉, 骨质疏松症, 骨水泥, 聚甲基丙烯酸甲酯, 腰椎退行性病变, 目测类比评分

Abstract:

BACKGROUND: Once lumbar degenerative diseases merge with lumbar spinal stenosis, lumbar instability and degenerative scoliosis, surgical therapy is required for corresponding clinical symptoms, and the usage of internal fixators cannot be inevitable. Osteoporosis is rather common in the elderly. Therefore, how to implant stable pedicle screw fixation system in serious osteoporosis patients will be a big difficulty. In recent years, some studies have proven the biomechanical stability of polymethylmethacrylate augmentation of a  cannulated and fenestrated pedicle screw in the vertebral body, so it becomes very hot in the spine surgery.
OBJECTIVE: To explore the clinical efficacy of the use of polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw fixation for the treatment of lumbar degenerative disease accompanied with osteoporosis.
METHODS: Thirty-one patients with lumbar degenerative disease accompanied with osteoporosis from Jun 2008 to Jan 2013 were selected, including 11 males and 20 females with an average age of 73.5 years (range, 65-86 years). There were 14 cases of lumbar degenerative stenosis, 9 of lumbar intervertebral disc herniation combined with segmental instability, 6 of lumbar degenerative spondylolisthesis, and 2 of lumbar degenerative scoliosis. The patients were treated with lumbar canal decompression, fusion and polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw fixation according to their clinical features and imaging data. Visual analog scale for pain evaluation was used before and after fixation, the Japanese Orthopaedic Association (JOA) scale was used for assessment of neurological function and life skills before internal fixation and during follow-up.
RESULTS AND CONCLUSION: All cases were followed up for 40 months (range, 36-48months). No screw breakage, rod breakage, screw extraction, loosening, pseudoarticulation formation, or incision infection was found. The postoperative visual analog scale score and the JOA score was remarkably improved (P < 0.05). For patients suffering from lumbar degenerative disease accompanied with osteoporosis, polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw fixation is helpful for increasing the stabilization of screw and preventing from loosening and dislocation of the screws, and thereby beneficial for improvement and maintenance of clinical efficacy.


中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程


全文链接：

Key words: lumbar vertebrae, osteoporosis, internal fixators, follow-up studies

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