CAJ | 학술논문

骨组织工程%骨科植入物%骨质疏松%骨水泥%椎弓根螺钉%相邻节段%椎间隙高度%椎体矩形指数%终板凹陷角度%Oswestry功能障碍指数评分%Cobb角骨組織工程%骨科植入物%骨質疏鬆%骨水泥%椎弓根螺釘%相鄰節段%椎間隙高度%椎體矩形指數%終闆凹陷角度%Oswestry功能障礙指數評分%Cobb角
골조직공정%골과식입물%골질소송%골수니%추궁근라정%상린절단%추간극고도%추체구형지수%종판요함각도%Oswestry공능장애지수평분%Cobb각
bone tissue engineering%orthopedic implants%osteoporosis%bone cement%pedicle screw%adjacent segment%intervertebral space height%vertebral rectangular index%concave angle of vertebral end-plate%Oswestry disability index%Cobb angle

背景:在对伴骨质疏松的腰椎疾病患者进行椎弓根螺钉固定手术时,椎体添加骨水泥可有效增加内固定稳定性,但对相邻节段的影响尚不明确. 目的:观察伴骨质疏松的腰椎疾病患者进行椎体骨水泥强化内固定后,早中期随访中骨水泥强化对相邻节段的影响. 方法:以87例伴骨质疏松的腰椎疾病患者为研究对象,均行椎弓根螺钉系统固定+后路椎管减压术,并分为3组:常规螺钉组,常规螺钉+骨水泥组,可灌注骨水泥螺钉+骨水泥组.样本平均随访6-18个月,平均随访为9个月.测量术前、术后3 d、末次随访的Oswestry功能障碍指数评分、固定节段上位相邻椎间隙高度、固定节段上位相邻椎体变形指数、固定节段椎体上缘终板及相邻上位椎体下缘终板凹陷角度、固定节段Cobb角. 结果与结论:①常规螺钉组、常规螺钉+骨水泥组、可灌注骨水泥螺钉+骨水泥组3组内末次随访功能障碍指数评分均较前明显减小(P<0.05),组间两两对比无显著差异(P>0.05).表明骨质疏松患者脊柱后路固定时,是否添加骨水泥及不同添加方式,对早中期主观疗效影响无显著差异,且均可明显改善患者生活质量.②常规螺钉+骨水泥组、可灌注骨水泥螺钉+骨水泥组2组末次随访对术后3 d固定节段Cobb角变化小于常规螺钉组(P <0.05),常规螺钉+骨水泥组、可灌注骨水泥螺钉+骨水泥组2组组间差异无统计学意义(P >0.05).表明添加骨水泥辅助的内固定稳定性明显优于未添加骨水泥常规手术.③常规螺钉+骨水泥组、可灌注骨水泥螺钉+骨水泥组2组术后3 d出现上终板凹陷角度增大;末次随访观察到相邻上位椎体下终板凹陷角度、椎体矩形指数及相邻椎间隙均减小,且前两项指标的改变程度明显大于常规螺钉组.表明添加骨水泥辅助内固定对相邻椎间盘退变程度无显著影响,但明显改变了相邻椎体终板及椎体的形态,增加了相邻椎体发生骨折的风险. 揹景:在對伴骨質疏鬆的腰椎疾病患者進行椎弓根螺釘固定手術時,椎體添加骨水泥可有效增加內固定穩定性,但對相鄰節段的影響尚不明確. 目的:觀察伴骨質疏鬆的腰椎疾病患者進行椎體骨水泥彊化內固定後,早中期隨訪中骨水泥彊化對相鄰節段的影響. 方法:以87例伴骨質疏鬆的腰椎疾病患者為研究對象,均行椎弓根螺釘繫統固定+後路椎管減壓術,併分為3組:常規螺釘組,常規螺釘+骨水泥組,可灌註骨水泥螺釘+骨水泥組.樣本平均隨訪6-18箇月,平均隨訪為9箇月.測量術前、術後3 d、末次隨訪的Oswestry功能障礙指數評分、固定節段上位相鄰椎間隙高度、固定節段上位相鄰椎體變形指數、固定節段椎體上緣終闆及相鄰上位椎體下緣終闆凹陷角度、固定節段Cobb角. 結果與結論:①常規螺釘組、常規螺釘+骨水泥組、可灌註骨水泥螺釘+骨水泥組3組內末次隨訪功能障礙指數評分均較前明顯減小(P<0.05),組間兩兩對比無顯著差異(P>0.05).錶明骨質疏鬆患者脊柱後路固定時,是否添加骨水泥及不同添加方式,對早中期主觀療效影響無顯著差異,且均可明顯改善患者生活質量.②常規螺釘+骨水泥組、可灌註骨水泥螺釘+骨水泥組2組末次隨訪對術後3 d固定節段Cobb角變化小于常規螺釘組(P <0.05),常規螺釘+骨水泥組、可灌註骨水泥螺釘+骨水泥組2組組間差異無統計學意義(P >0.05).錶明添加骨水泥輔助的內固定穩定性明顯優于未添加骨水泥常規手術.③常規螺釘+骨水泥組、可灌註骨水泥螺釘+骨水泥組2組術後3 d齣現上終闆凹陷角度增大;末次隨訪觀察到相鄰上位椎體下終闆凹陷角度、椎體矩形指數及相鄰椎間隙均減小,且前兩項指標的改變程度明顯大于常規螺釘組.錶明添加骨水泥輔助內固定對相鄰椎間盤退變程度無顯著影響,但明顯改變瞭相鄰椎體終闆及椎體的形態,增加瞭相鄰椎體髮生骨摺的風險.
배경:재대반골질소송적요추질병환자진행추궁근라정고정수술시,추체첨가골수니가유효증가내고정은정성,단대상린절단적영향상불명학. 목적:관찰반골질소송적요추질병환자진행추체골수니강화내고정후,조중기수방중골수니강화대상린절단적영향. 방법:이87례반골질소송적요추질병환자위연구대상,균행추궁근라정계통고정+후로추관감압술,병분위3조:상규라정조,상규라정+골수니조,가관주골수니라정+골수니조.양본평균수방6-18개월,평균수방위9개월.측량술전、술후3 d、말차수방적Oswestry공능장애지수평분、고정절단상위상린추간극고도、고정절단상위상린추체변형지수、고정절단추체상연종판급상린상위추체하연종판요함각도、고정절단Cobb각. 결과여결론:①상규라정조、상규라정+골수니조、가관주골수니라정+골수니조3조내말차수방공능장애지수평분균교전명현감소(P<0.05),조간량량대비무현저차이(P>0.05).표명골질소송환자척주후로고정시,시부첨가골수니급불동첨가방식,대조중기주관료효영향무현저차이,차균가명현개선환자생활질량.②상규라정+골수니조、가관주골수니라정+골수니조2조말차수방대술후3 d고정절단Cobb각변화소우상규라정조(P <0.05),상규라정+골수니조、가관주골수니라정+골수니조2조조간차이무통계학의의(P >0.05).표명첨가골수니보조적내고정은정성명현우우미첨가골수니상규수술.③상규라정+골수니조、가관주골수니라정+골수니조2조술후3 d출현상종판요함각도증대;말차수방관찰도상린상위추체하종판요함각도、추체구형지수급상린추간극균감소,차전량항지표적개변정도명현대우상규라정조.표명첨가골수니보조내고정대상린추간반퇴변정도무현저영향,단명현개변료상린추체종판급추체적형태,증가료상린추체발생골절적풍험.
@@@@BACKGROUND:During the pedicle screw fixation for lumbar disease patients accompanied with osteoporosis, addition of bone cement in osteoporotic vertebral body can significantly increase the stability of internal fixation, but the effect on adjacent segments is not clear. @@@@OBJECTIVE:To observe the effect on adjacent segments of osteoporosis patients after pedicle screw fixation augmented with bone cement in early and medium-term fol ow-up period. @@@@METHODS:We reviewed the medical information of 87 patients suffering from lumbar disease accompanied with osteoporosis who underwent operation of pedicle screw fixation and posterior lumbar spinal decompression, and the patients were divided into three groups:conventional pedicle screw group, conventional pedicle screw+bone cement group, novel perfusional pedicle screw+bone cement group. The samples were fol owed-up for 6-18 months, averaged 9 months. The Oswestry disability index, intervertebral distance of the upper adjacent segments, deformation index of the upper adjacent vertebral body, concave angle of the fixed lumbar vertebrae superior end-plate and the upper adjacent vertebral body inferior end-plate, and Cobb angle were measured before operation, at 3 days postoperation and during final fol ow-up. @@@@RESULTS AND CONCLUSION:The Oswestry disability index of the final fol ow-up in the three groups were decreased when compared with that before operation (P<0.05), but there was no significant difference between any two groups (P>0.05). This showed that in posterior spinal fixation operation, there was no significant difference in the early and medium-term subjective effect between addition of bone cement or not and different adding ways, and addition of bone cement or not and different adding ways could remarkably improve the life quality of the patients. The change of Cobb angle of fixed lumbar vertebrae between the final fol ow-up and 3 days after operation in conventional pedicle screw+bone cement group and novel perfusional pedicle screw+bone cement group was both less than that in the conventional pedicle screw group (P<0.05), and there was no significant difference between conventional pedicle screw+bone cement group and novel perfusional pedicle screw+bone cement group (P>0.05). This showed that the stability of internal fixation augmented with bone cement was much better than the routine operation without bone cement. The concave angle of upper end-plate was increased in conventional pedicle screw+bone cement group and novel perfusional pedicle screw+bone cement group at 3 days after operation when compared with that in the conventional pedicle screw group;the lower end-plate concave angle of adjacent centrum, the rectangular index and the adjacent intervertebral space of conventional pedicle screw+bone cement group and novel perfusional pedicle screw+bone cement group were al decreased in the final fol ow-up, and the change of the first two indicators was significantly bigger than those in the conventional pedicle screw group. This showed that addition of bone cement in internal fixation operation had no significant effect on the degeneration degree of adjacent intervertebral disc, but it obviously changed the modality of adjacent vertebral endplate and vertebral body, and increased the fracture risk of adjacent vertebral body.