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| 可膨胀椎弓根螺钉在骨质疏松性脊柱固定手术中的应用 |
| Application of expandable pedicle screws in fixation of osteoporotic lumbar spine |
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| DOI： |
| 中文关键词: 膨胀式椎弓根螺钉 骨质疏松 脊柱融合术 治疗结果 |
| 英文关键词:Expandable pediele screw Osteoporosis Spinal fusion Treatment outcome |
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| 中文摘要: |
| 目的 评价膨胀式椎弓根螺钉(expandable pediele screw，EPS)在骨质疏松情况下的胸腰椎疾病经椎弓根固定的可靠性。方法 回顾性分析2008年1月至2010年12月收治且定期随访至少12个月的骨质疏松合并腰椎疾患行后路手术患者56例(随机、非盲)，男25例，女3l例；年龄45岁-72岁，平均61.3岁；病程2个月-5年，平均13.5个月。其中腰椎问盘突出症9例，腰椎管狭窄症14例，腰椎滑脱(按Meyerding分级)：I度7例，Ⅱ度6例，Ⅲ度3例，胸腰椎结核2期后路融合手术6例，压缩性骨折7例、翻修手术4例。术前均采用双能x线吸收法(DXA)，按照国际临床骨密度学会ISCD的质量控制要求，采用美国GE公司骨密度仪，检测腰椎骨密度(bone mineral density，BMD)，证实BMD平均下降2.7个标准差。手术方式均采用腰椎后路椎弓根螺钉系统固定，患者被随机分组，采用EPS螺钉固定28例，普通椎弓根螺钉固定28例；随访观察患者疼痛视觉模拟评分(visualanalogue scale，VAS)、改良Prolo功能评分，重点通过x线、CT的影像学检查评估螺钉稳定性及融合情况。结果 所有患者均获15—24月随访，平均18月；EPS组术后1年有85.7％的患者螺钉位置稳定，脊柱融合率为85.7％，在EPS组中1例患者在第2次手术取钉时出现断钉情况；CPS组术后1年仅有60.0％的患者螺钉位置稳定，脊柱融合率为85.O％，未出现螺钉取出困难情况；术前、术后3个、术后6个月、术后12个月的VAS及改良Prolo功能评分显示较术前改善，但两组问差异不具统计学意义；同时所有患者中出现并发症的有16例(33.3％)、输血病例22例(45.8％)，但两组之间并发症比较不具统计学意义。结论 在胸腰椎疾病患者合并骨质疏松条件下采用EPS固定是稳定、有效的，EPS相比CPS可获得更强的固定能力，能有效地解决术后螺钉松动、脱落等问题，适宜用于在骨质疏松性脊柱疾病的融合固定手术中使用。且操作较为简单，不会增加手术时间及出血量。同时因骨质疏松性脊柱疾病多为年龄较大患者，故手术并发症相对较多，应更重视围手术期管理。 |
| 英文摘要: |
| Abstract：0bjective To evaluate the reliability of the expandable pedicle screw(EPS)fixation for thoracolumbar spine disease in patients with osteoporosis．Methods A retrospective analysis was performed．From January 2008 to December 2010，56 patients with thoracolumbar disease and osteoporosis who undergone back-path surgery were treated and followed up regularly for at least 12 months，including 25 men and 31 women，with an average age of 61.3 years old(45-72 years old)．The course of the disease was between 2 months and 5 years，with an average of 13.5 months．Among the 56 patients，there were 9 cases of lumbar disc herniation，14 cases of stenosis，7 cases of lst degree，6 of 2nd degree，and 3 of 3 rd degree of spondylothisthesis，6 cases of spinal tuberculosis with 2 times back-path fusion surgery，7 cases of compression fractures，and 4 cases of revision surgery．Bone mineral density(BMD)was tested with dualenergy X-ray absorptiometry(GE)in all patients before surgery．An average decrease of 2.7 standard deviations of BMD was found，according to ISCD standard．EPS posterior spinal fixation was applied in all surgery．The patients were randomly divided into two groups，28 patients with EPS posterior spinal fixation，and 28 patients with conventional posterior spinal fixation．Visual analogue scale(VAS)，modified Prolo functional scores，X-ray，and CT were used to follow up and to evaluate the pain and stability and integration of the screw．Results The mean follow-up period was 18 months(15-24 months)．In EPS group，85.7％ of the screw placements were stable．and the spinal fusion rate was 85.7％in 1 year after the operation．EPS breaking occurred in 1 patient during the process of removal in EPS group．In CPS group．only 60.0％of the screw placements were stable．and the spinal fusion rate was 85.O％in 1 year after the operation．No difficulty occurred during the withdrawing of the screw．Both VAS and modified Prolo functional scores showed a significant improvement on 3，6，and 12 months after the surgery，with no statistical significance between the two groups．Complication occurred in 16 patients(33.3％)among all the cases．Twenty-two cases(45.8％)required blood transfusions．There was no significant difference between the two groups．Conclusion For patients with thoracolumbar disease combined with osteoporosis，EPS fixation was stable and effective，and was more fixable than CPS．EPS fixation could solve several postoperative problems such as screw loosening and loss．It was suitable in fusion and fixation surgery for osteoporotic spinal diseases．And the operation was simple without increasing operation time and blood loss．Because the patients with osteoporotic spinal disease are older and more susceptible tO complications，close attention should be paid during the perioperative period． |
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