CAJ | 학술논문

背景：骨质疏松伴腰椎退行性病变行椎弓根钉固定骨质疏松的椎体后可能会出现螺钉的松动、脱落，使用固化材料强化椎弓根钉能提高治疗效果。 　　目的：比较骨质疏松患者腰椎内固定中使用聚甲基丙烯酸甲酯骨水泥和可注射硫酸钙骨水泥加强椎弓根钉两种技巧的临床效果。 　　方法：腰椎滑脱、腰椎失稳、严重腰椎管狭窄合并骨质疏松的患者共61例，根据治疗方式分为2组：传统聚甲基丙烯酸甲酯强化椎弓根钉组和可注射硫酸钙骨水泥强化椎弓根钉组。 　　结果与结论：两组患者治疗操作时间、出血量、治疗前后目测类比评分、日本骨科协会评估治疗分数评分及改善率比较差异均无显著性意义(P>0.05)。聚甲基丙烯酸甲酯组中2例患者出现了注入的骨水泥渗漏，随访未造成新的神经损伤。聚甲基丙烯酸甲酯组患者治疗后骨密度随着随访时间的延长未出现逐渐的增强趋势；硫酸钙骨水泥组患者治疗后骨密度出现渐进性的改善，与患者治疗后日本骨科协会评估治疗分数改善率呈线性相关。两组患者未出现螺钉松动、拔出及神经功能的异常。表明与聚甲基丙烯酸甲酯相似，硫酸钙骨水泥能增加椎弓根螺钉的稳定性。
배경：골질소송반요추퇴행성병변행추궁근정고정골질소송적추체후가능회출현라정적송동、탈락，사용고화재료강화추궁근정능제고치료효과。 　　목적：비교골질소송환자요추내고정중사용취갑기병희산갑지골수니화가주사류산개골수니가강추궁근정량충기교적림상효과。 　　방법：요추활탈、요추실은、엄중요추관협착합병골질소송적환자공61례，근거치료방식분위2조：전통취갑기병희산갑지강화추궁근정조화가주사류산개골수니강화추궁근정조。 　　결과여결론：량조환자치료조작시간、출혈량、치료전후목측류비평분、일본골과협회평고치료분수평분급개선솔비교차이균무현저성의의(P>0.05)。취갑기병희산갑지조중2례환자출현료주입적골수니삼루，수방미조성신적신경손상。취갑기병희산갑지조환자치료후골밀도수착수방시간적연장미출현축점적증강추세；류산개골수니조환자치료후골밀도출현점진성적개선，여환자치료후일본골과협회평고치료분수개선솔정선성상관。량조환자미출현라정송동、발출급신경공능적이상。표명여취갑기병희산갑지상사，류산개골수니능증가추궁근라정적은정성。
BACKGROUND:Screw loosening and shedding may occur after osteoporosis associated with lumbar degenerative disease treated with pedicle screw fixation. Application of pedicle screw enhanced with cured materials can improve the therapeutic effect. OBJECTIVE:To compare the clinical effect of pedicle screws enhanced with poly(methyl methacrylate) and injectable calcium sulfate cement in the lumbar internal fixation of osteoporosis. METHODS:Sixty-one patients diagnosed with osteoporosis combined with lumbar spondylolisthesis, lumbar spinal instability, and severe lumbar spinal stenosis were col ected. Al patients were divided into two groups according to the treatment method:poly(methyl methacrylate) bone cement enhanced pedicle screw group and calcium sulfate bone cement enhanced pedicle screw group. RESULTS AND CONCLUSION:There were no significant differences in the operation time, blood loss, preoperative and postoperative visual analog scale score, Japanese Orthopedic Association scores and the Japanese Orthopedic Association score improvement rate between two groups (P>0.05). The results showed that two patients had bone cement leakage in poly(methyl methacrylate) group which had no neurological symptoms caused by new symptoms during fol ow-up period. The bone mineral density was not improved gradual y in poly(methyl methacrylate) group with fol ow-up time prolonging;however, in calcium sulfate group, the bone mineral density was increased significantly after treatment, and the change of bone mineral density was linearly related with Japanese Orthopaedic Association score improvement rate in calcium sulfate group. No screw loosening, pul ing out or neurological dysfunction occurred in both groups. The results indicate that like poly(methyl methacrylate), balcium sulfate bone cement can increase the stability of pedicle screws.