摘要
目的:观察可灌注骨水泥螺钉在伴有骨质疏松的腰椎退行性疾病中的早期疗效。方法:回顾性分析2015年6月至2017年6月采用可灌注骨水泥螺钉内固定后外侧植骨融合术治疗伴有中重度骨质疏松的腰椎退行性疾病28例,其中男9例,女19例,年龄55~86岁,平均76岁。术前行腰椎正侧位、双斜位及动力位X线摄片,腰椎CT、MRI及双能X射线骨密度仪(DXA)检查明确诊断。28例患者均有中重度腰椎管狭窄,其中合并退行性脊柱侧弯16例,退行性腰椎滑脱12例,腰椎间盘突出16例。骨质疏松按Jikei分级,Ⅱ级9例,Ⅲ级19例。采用视觉模拟评分法(VAS)和日本骨科协会(JOA)腰痛疾患评分标准评定患者腰腿痛及神经功能改善情况。采用影像学资料观察有无椎弓根螺钉松动、脱出、断裂及骨水泥渗漏情况发生,对融合情况进行综合评定。结果:28例患者住院时间10~14 d,平均12 d;手术时间100~150 min,平均120 min;出血量200~600 ml,平均350 ml(3节段以上手术,术中使用血液过滤回收),术后引流量150~600 ml,平均300 ml,均未使用异体血;每椎体骨水泥注入量2~3 ml,注入中2例出现骨水泥渗漏,均为椎旁血管渗漏,无椎管内渗漏迹象;及时终止骨水泥注入,未发生神经损伤、骨水泥毒性反应以及血管栓塞、肺栓塞等重度并发症。依据X线片评估标准,18例达到坚强骨融合,10例属于不确切性融合,但融合节段未出现假关节形成。未出现螺钉松动、脱出、断裂现象。VAS、JOA评分均有明显改善。结论:可灌注骨水泥螺钉技术治疗伴有骨质疏松的腰椎管狭窄症效果满意。
Objective:To observe the early clinical effect of perfusion bone cement screw for lumbar degenerative diseases with osteoporosis.Methods:The clinical data of 28 patients with lumbar degenerative diseases combined with moderate to severe osteoporosis treated by posterior lateral graft fusion with perfusion of bone cement screws from June 2015 to June 2017 were retrospectively analyzed.There were 9 males and 19 females,aged from 55 to 86 years old with an average of 76 years.Anteroposterior,oblique,and dynamic radiography were performed before operation,and the diagnosis was confirmed by CT,MRI and dual energy X-ray absorptionmetry(DXA).All the patients had moderate to severe lumbar spinal stenosis including16 cases with degenerative scoliosis,12 cases with degenerative lumbar spondylolisthesis,and 16 cases with lumbar disc herniation.According to Jikei grade of osteoporosis,9 cases were gradeⅡand 19 cases were gradeⅢ.Visual analogue scale(VAS)and Japanese Orthopaedic Association(JOA)score were used to assess the improvement of lumbar leg pain,and neurological function.Imaging data were used to observe the circumstance of pedicle loosening,prolapse,breakage and bone cement leakage,and comprehensively evaluate the fusion.Results:The hospital stay was from 10 to 14 days with an average of 12 days;the operative time was 100 to 150 min with an average of 120 min;the blood loss was 200 to 600 ml with an average of 350 ml(for operations more than 3 vertebral segments,blood filtration recovery was intraoperatively used);the postoperative drainage volume was 150 to 600 ml with an average of 300 ml,no allogeneic blood was used in all the patients.Bone cement of 2 to 3 ml were injected into each vertebral body,and bone cement leakage occurred in 2 cases during injection,both of which were paravertebral vessel leakage,and there was no evidence of intravertebral leakage.The injection of bone cement was terminated in a timely manner without serious complications such as nerve injury,bone cement toxicity,and vascular emboliz
作者
曲弋
俞兴
王逢贤
杨济洲
杨永栋
赵丁岩
王河军
陈思学
QU Yi;YU Xing;WANG Feng-xian;YANG Ji-zhou;YANG Yong-dong;ZHAO Ding-yan;WANG He-jun;CHEN Si-xue(Department of Orthopaedics,Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine,Beijing 100700,China;不详)
出处
《中国骨伤》
CAS
CSCD
2019年第10期928-932,共5页
China Journal of Orthopaedics and Traumatology
关键词
腰椎退变
椎管狭窄
骨质疏松
椎弓根螺钉
骨水泥
Lumbar degeneration
Spinal stenosis
Osteoporosis
Pedicle screw
Bone cement
