中国组织工程研究

中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (4): 517-521.doi: 10.3969/j.issn.2095-4344.2016.04.011

• 脊柱植入物 spinal implant • 上一篇    下一篇

骨水泥螺钉强化固定伴骨质疏松腰椎滑脱症的稳定性及椎间融合

姚珍松，唐永超，陈  康，江晓兵，梁  德，晋大祥，庄  洪，张顺聪，杨志东，丁金勇   

  1. 广州中医药大学第一附属医院脊柱专科，广东省广州市 510405
  • 收稿日期:2015-12-05 出版日期:2016-01-22 发布日期:2016-01-22
  • 通讯作者: 梁德，主任医师，教授，博士生导师，广州中医药大学第一附属医院脊柱专科，广东省广州市 510405
  • 作者简介:姚珍松，男，1971年生，博士，副主任医师，主要从事脊柱退变及创伤相关疾病的研究。
  • 基金资助:
    卫生部医药卫生科技发展研究中心资助课题(W2014ZT256, W2012ZT0)；广东省卫生厅医学科研基金(2014B2014175)

Stability and interbody fusion of augmented pedicle screws with bone cement for lumbar spondylolisthesis accompanied with osteoporosis

Yao Zhen-song, Tang Yong-chao, Chen Kang, Jiang Xiao-bing, Liang De, Jin Da-xiang, Zhuang Hong, Zhang Shun-cong, Yang Zhi-dong, Ding Jin-yong   

  1. Department of Spinal Surgery, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Received:2015-12-05 Online:2016-01-22 Published:2016-01-22
  • Contact: Liang De, Chief physician, Professor, Doctoral supervisor, Department of Spinal Surgery, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • About author:Yao Zhen-song, Ph.D., Associate chief physician, Department of Spinal Surgery, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Supported by:

    a grant from Medical and Health Science and Technology Development Research Center of Ministry of Health, No. W2014ZT256, W2012ZT0; the Medical Science and Technology Foundation of Department of Health of Guangdong Province, No. 2014B2014175

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摘要：

文章快速阅读：

文题释义：

合并骨质疏松的腰椎滑脱：该类病变通常需要通过椎间撬拨及钉棒纵向提拉来达到复位效果，对螺钉抗拔出力的要求更高，如果骨质疏松严重，复位时易发生螺钉松动、拔出，或者修复后容易出现复位丢失及内固定失败。因此，需要寻找提高椎弓根螺钉固定强度的方法。
骨水泥强化椎弓根螺钉内固定：通过骨水泥强化钉道后，能显著提高螺钉的轴向拔出力和抗疲劳能力，提高骨质疏松患者后路椎弓根螺钉固定的稳定性，因此在需使用内固定参与矫形或复位时可考虑应用。

 

背景：对于骨质疏松严重的腰椎滑脱症患者，复位时易发生螺钉松动、拔出，或者修复后容易出现复位丢失及内固定失败，因此修复过程中提高椎弓根螺钉固定强度非常重要。目前有关骨水泥螺钉强化技术应用于伴骨质疏松腰椎滑脱症患者的报道较少。
目的：探讨聚甲基丙烯酸甲酯骨水泥强化椎弓根螺钉置入内固定在伴骨质疏松腰椎滑脱症中的应用价值。
方法：将2009年6月至2011年6月收治的27例伴骨质疏松的腰椎滑脱症患者纳入回顾性分析，均行聚甲基丙烯酸甲酯骨水泥强化椎弓根螺钉置入内固定治疗。采用Oswestry功能障碍指数、目测类比评分评价功能障碍与疼痛程度，治疗后以影像学检查评估内固定与融合情况，记录并发症。
结果与结论：患者获得15-37个月随访。末次随访Oswestry功能障碍指数、目测类比评分均显著优于治疗前，差异有显著性意义(P < 0.05)。治疗后影像学结果显示所有患者的骨水泥与骨质界面结合紧密，螺钉及骨水泥位置良好，未发生有症状的骨水泥渗漏，末次随访无内固定失败，患者均获椎间融合。提示聚甲基丙烯酸甲酯骨水泥可增加骨质疏松椎体中椎弓根螺钉的把持力，骨水泥钉道强化固定伴骨质疏松的腰椎滑脱症安全有效，可得到满意的固定稳定性及椎间融合。 

ORCID: 0000-0001-5160-1103(姚珍松)

关键词: 骨科植入物, 脊柱植入物, 腰椎滑脱症, 骨质疏松, 椎弓根螺钉, 钉道强化, 骨水泥, 聚甲基丙烯酸甲酯, 椎间融合

Abstract:

BACKGROUND: In lumbar spondylolisthesis patients with severe osteoporosis, screw is easily loose and pulls out during reposition, or loss of reduction and internal fixation failure easily occur after repair. Therefore, it is very 
important to elevate the intensity of pedicle screw fixation during repair. At present, few studies concern application of bone cement screw enhancement technology in lumbar spondylolisthesis patients with osteoporosis.
OBJECTIVE: To investigate the clinical value of augmented pedicle screw with polymethylmethacrylate for lumbar spondylolisthesis accompanied with osteoporosis. METHODS: From June 2009 to June 2011, 27 patients suffering from lumbar spondylolisthesis accompanied with osteoporosis were included in this retrospective study. These patients received augmented pedicle screw with polymethylmethacrylate. The levels of disability and pain were evaluated by Oswestry Disability Index and visual analog scale. The internal fixation and fusion were evaluated by radiological findings. All complications were recorded.
RESULTS AND CONCLUSION: All cases were followed up for 15-37 months. Oswestry Disability Index and visual analog scale scores were significantly better in final follow-up than that pre-treatment (P < 0.05). Imaging results revealed that bone cement tightly connected to bone interface. The position of screw and bone cement was good. Symptomatic bone cement leakage was not found. No fixation failure was detected during final follow-up. All patients achieved interbody fusion. These results suggested that polymethylmethacrylate bone cement could increase the gripping force of the pedicle screw in osteoporotic vertebral body. It is safe and effective to treat spondylolisthesis accompanied with osteoporosis with augmented pedicle screws. Satisfactory fixation stability and interbody fusion can be obtained.