CAJ | 학술논문

背景：老年腰椎退变患者在手术中常面临椎弓根螺钉把持力不足情况，易发生脱钉、固定不牢靠等风险，如何增加螺钉的把持力成为研究的热点。目的：探讨使用椎弓根螺钉骨水泥强化方案治疗老年腰椎退变的早期临床效果。方法：选择2012年8月至2014年4月收治的患腰椎退行性疾病行腰椎内固定治疗的患者65例，根据修复方案分为2组，椎弓根螺钉内固定骨水泥强化组24例，常规椎弓根螺钉内固定组41例。比较两组患者的一般情况，采用目测类比评分法和日本矫形科学学会腰椎功能评分表对患者腰背疼痛及下肢神经功能恢复情况进行评估。结果与结论：65例患者均完成手术，获得随访，随访时间为3-20个月，随访中均行腰椎正侧位片X射线片，未发现螺钉松动、脱落、断裂、椎间隙高度丢失等情况。椎弓根螺钉内固定骨水泥强化组患者的手术出血量、住院时间与常规椎弓根螺钉内固定组差异无显著性意义(P>0.05)，椎弓根螺钉内固定骨水泥强化组术后3，6个月日本矫形科学学会腰椎功能评分及术后3个月的目测类比评分均较常规椎弓根螺钉内固定组显著改善(P <0.05)；两组术后6个月的目测类比评分差异无显著性意义(P >0.05)。提示将骨水泥沿椎弓根螺钉钉道注入椎弓根及椎体，可达到螺钉骨水泥强化的目的，增加螺钉的把持力，重建腰椎的稳定性，取得了满意的近期疗效。
배경：노년요추퇴변환자재수술중상면림추궁근라정파지력불족정황，역발생탈정、고정불뢰고등풍험，여하증가라정적파지력성위연구적열점。목적：탐토사용추궁근라정골수니강화방안치료노년요추퇴변적조기림상효과。방법：선택2012년8월지2014년4월수치적환요추퇴행성질병행요추내고정치료적환자65례，근거수복방안분위2조，추궁근라정내고정골수니강화조24례，상규추궁근라정내고정조41례。비교량조환자적일반정황，채용목측류비평분법화일본교형과학학회요추공능평분표대환자요배동통급하지신경공능회복정황진행평고。결과여결론：65례환자균완성수술，획득수방，수방시간위3-20개월，수방중균행요추정측위편X사선편，미발현라정송동、탈락、단렬、추간극고도주실등정황。추궁근라정내고정골수니강화조환자적수술출혈량、주원시간여상규추궁근라정내고정조차이무현저성의의(P>0.05)，추궁근라정내고정골수니강화조술후3，6개월일본교형과학학회요추공능평분급술후3개월적목측류비평분균교상규추궁근라정내고정조현저개선(P <0.05)；량조술후6개월적목측류비평분차이무현저성의의(P >0.05)。제시장골수니연추궁근라정정도주입추궁근급추체，가체도라정골수니강화적목적，증가라정적파지력，중건요추적은정성，취득료만의적근기료효。
BACKGROUND:Elderly patients with degenerative lumbar degeneration often appear insufficient holding power of pedicle screw in spine surgery, which is prone to occur de-pinning and leads to insecure fixation. How to increase the holding power of screws has become a hot research. OBJECTIVE:To observe the early clinical effect of pedicle screws with cement augmentation for treating lumbar degenerative diseases in elderly patients. METHODS:A total of 65 old patients with lumbar degenerative diseases received a treatment between August 2012 and April 2014, and were divided into two groups according to the treatment strategy:treatment group (n=24;internal fixation of pedicle screws with cement augmentation) and control group (n=41;routine internal fixation of pedicle screws). General conditions of patients in two groups were observed and compared. Visual analog scale (VAS) and Japanese Orthopaedic Association (JOA) score system were used for evaluating the lumbar and back pain, and restoration of neurological function in lower limbs respectively. RESULTS AND CONCLUSION:Al of the patients successful y received the surgery and then were fol owed up from 3 to 20 months. The anterioposterior and lateral X-ray film revealed no loosening, loss, fracture of the screws, and no loss of intervetebral space height was found. There was no significant difference in the blood loss and hospital stay between two groups (P>0.05). JOA at postoperative 3 and 6 months, and VAS score at postoperative 3 months were significantly improved after the treatment of pedicle screws with cement augmentation, when compared to control group (P<0.05). VAS scores showed no difference at 6 months postoperatively in two groups (P>0.05). Pedicle screws with cement augmentation for treating lumbar degenerative diseases have the advantages of improving the screws holding strength, reconstructing the stability of lumbar vertebra and obtaining clinical efficacy on degenerative spine.