CAJ | 학술논문

目的探讨膨胀式椎弓根螺钉结合骨水泥强化钉道在治疗严骨质疏松性脊柱内固定手术中的早期疗效。方法自2006年10月至2008年10月对20例需行内固定治疗同时合并严重骨质疏松的腰椎疾病患者采用膨胀式椎弓根螺钉结合骨水泥强化钉道进行脊柱后路稳定手术，其中男9例，女11例；年龄43～73岁，平均59岁。分别于术后1周、3个月、6个月、12个月及24个月摄动力位X线片及CT扫描，了解螺钉稳定性、骨水泥分布及脊柱融合情况。术前及术后3个月时应用日本矫形外科协会(JOA)不腰痛评分及视觉模拟评分(VAS)评价疗效。结果本组共置人膨胀式椎弓根螺钉168枚。所有患者术后获12～ 38个月（平均26个月）随访。术前及术后3个月JOA评分平均分别为(11.4±2.6)分和(24.9±1.6)分，差异有统计学意义(t= 19.776，P=0.000)；术前及术后3个月VAS评分分别为(7.0±1.4)分和(2.1±1.3)分，差异有统计学意义(t=11.470，P=0.000)。螺钉及骨水泥在椎体内位置稳定，周围骨小梁致密，未见明显透光带，无内固定松动移位迹象；后外侧融合节段植骨愈合良好，椎体间或椎板、关节突及棘突旁有连续性骨小梁形成，连接上下椎体。临床症状明显缓解，无早期及晚期感染等并发症发生，无临床复发。结论对于合并严重骨质疏松的脊柱后路内固定手术，膨胀式椎弓根螺钉结合骨水泥强化钉道的方法能够极大地提高螺钉固定的稳定性。
목적 탐토팽창식추궁근라정결합골수니강화정도재치료엄골질소송성척주내고정수술중적조기료효。방법 자2006년10월지2008년10월대20례수행내고정치료동시합병엄중골질소송적요추질병환자채용팽창식추궁근라정결합골수니강화정도진행척주후로은정수술，기중남9례，녀11례；년령43～73세，평균59세。분별우술후1주、3개월、6개월、12개월급24개월섭동력위X선편급CT소묘，료해라정은정성、골수니분포급척주융합정황。술전급술후3개월시응용일본교형외과협회(JOA)불요통평분급시각모의평분(VAS)평개료효。결과 본조공치인팽창식추궁근라정168매。소유환자술후획12～ 38개월（평균26개월）수방。술전급술후3개월JOA평분평균분별위(11.4±2.6)분화(24.9±1.6)분，차이유통계학의의(t= 19.776，P=0.000)；술전급술후3개월VAS평분분별위(7.0±1.4)분화(2.1±1.3)분，차이유통계학의의(t=11.470，P=0.000)。라정급골수니재추체내위치은정，주위골소량치밀，미견명현투광대，무내고정송동이위적상；후외측융합절단식골유합량호，추체간혹추판、관절돌급극돌방유련속성골소량형성，련접상하추체。림상증상명현완해，무조기급만기감염등병발증발생，무림상복발。결론 대우합병엄중골질소송적척주후로내고정수술，팽창식추궁근라정결합골수니강화정도적방법능구겁대지제고라정고정적은정성。
Objective To evaluate the short-term clinical and radiographic results of a novel expandable pedicle screw instrumentation combined with cement augmentation in surgery for the severely osteoporotic spine.Methods From October 2006 to October 2008, 20 patients suffering from spinal diseases and severe osteoporosis were included in this clinical trial. They were 9 men and 11 women, with an average age of 59 years (range, 43 to 73 years). The preoperative bone mineral density (BMD) scan revealed a mean BMD decrease of 3.2 ±0.4. At one week, 3 months, 6 months and 12 months after surgery, plain radiography and three-dimensional CT scan were conducted to evaluate the spinal fusion and effectiveness of the instrumentation combined with cement augmentation, as well as the cement leakage. Functions were evaluated pre-operatively and 3 months post-operatively with Japanese Orthopaedic Association (JOA) and visual analog scores (VAS).Results Altogether 168 expandable pedicle screws were implanted. The mean follow-up period was 26 months (range, 12 to 38 months). The mean JOA and VAS improved respectively from 1 1. 4 ±2.6 and 7.0 ± 1.4 before operation to 24. 9 ± 1.6 and 2. 1 ± 1.3 at 3 months after operation( P ＜ 0. 05) .The three-dimensional CT scan observed cement leakage anteriolaterally to the fractured vertebral body (2cases) and to the adjacent disc (3 cases) without clinical sequelae. No cement leaked into the spinal canal.The spatial distribution of cement was satisfactory. There were no instances of loosening or pullout of the expandable pedicle screws. The screw-cement interface and cement-bone interface were excellent radiologically.Posterolateral radiologic fusion and bone healing around screws were achieved within 6 to 12 months after operation.ConclusionIn surgery for severely osteoporotic spine, excellent bone-screw interface and fixation strength can be achieved by expandable pedicle screw instrumentation combined with cement augmentation, a feasible novel fixation alternative for orthopaedic surgeons.