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骨水泥强化椎弓根钉方法治疗骨质疏松的比较研究
Comparative analysis of vertebrae strengthened by two ways of bone cement injection with the addition of pedicle screws fixation in the treatment of osteoporosis
目的 比较两种骨水泥强化椎弓根钉方法治疗骨质疏松的临床疗效。 方法 为38例骨质疏松患者行胸腰椎椎弓根钉固定手术治疗，第Ⅰ组21例采用直入式聚甲基丙烯酸甲酯(PMMA)骨水泥行椎体强化加椎弓根钉固定，第Ⅱ组17例采用后退式PMMA骨水泥行椎体强化加椎弓根钉固定，观察两组患者症状改善率、植骨融合率及时间、术后X线片、椎弓根钉有无松动、透亮线及并发症，比较两种方案的效果。 结果 38例患者得到9~36个月（平均16月）随访，两组患者症状缓解明显、植骨融合率明显增加；均无椎弓根钉松动或脱出；第Ⅰ组3例椎弓根钉周围有透亮线；第Ⅱ组3例骨水泥渗漏。 结论 应用PMMA行椎体强化椎弓根钉固定治疗骨质疏松可增强椎弓根钉把持力，有效防止椎弓根钉松动或脱出。
Objective To compare the clinical effects of two types of approach in the treatment of osteoporosis. Methods 38 cases of patients with osteoporosis underwent thoracolumbar pedicle screw fixation surgery. The vertebrae of the 21 patients in group I were strengthened by the direct approach of polymethyl methacrylate (PMMA) bone cement with the addition of pedicle screws. The vertebrae of 17 patients in group II were strengthened by the posterior approach of polymethyl methacrylate (PMMA) bone cement with the addition of pedicle screws. the rate of symptom improvement, the rate of bone graft fusion and fusion time, the postoperative plain radiograph, the condition of the pedicle screws, the bright line surrounding the screws, and the complications were compared between the two groups. Results 38 patients were followed up for 9~36 months(averaging 16 months). The rate of bone graft fusion significantly increased and symptoms significantly eased in patients of both groups. No pedicle screw has been found to loosen or prolase in both groups. The bright line was found around the pedicle screws from 3 patients in group I . Bone cement leakage in 3 patients occurred in the second group. Conclusion The vertebral strengthened by PMMA and pedicle screws fixation in patients with osteoporosis has the advantages of enhancing the holding of the pedicle screws, which could effectively prevent the pedicle screws from loosening and prolapsing.
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