CAJ | 학술논문

背景:骨质疏松患者置入椎弓根螺钉后,易发生螺钉松动和复位矫正丢失等固定不稳现象,因此,骨质疏松被认为是椎弓根螺钉的相对禁忌证. 目的:观察骨质疏松患者提高椎弓根螺钉稳定性方法的临床应用效果. 方法:34例骨质疏松患者行椎弓根螺钉内固定,术中采用了提高椎弓根螺钉稳定性方法.骨折患者14例(骨折组),骨病患者20例.20例骨病患者和5例骨折患者行脊柱后外侧或椎间植骨融合(融合组).骨质疏松按 Jikei 分级,初级8例,Ⅰ级11例,Ⅱ级8例,Ⅲ级7例.对19例初级和Ⅰ级骨质疏松患者,采用较粗和较长螺钉,同时结合采用螺钉与连接棒强直性连接,且有两根横向连接装置,左右、上下椎弓根螺钉分别在水平面和矢状面以较大成角置入螺钉等方法提高螺钉固定相对稳定性;对15例Ⅱ级和Ⅲ级骨质疏松患者,钉道注入骨水泥以提高螺钉固定绝对稳定性. 结果与结论:随访9-26个月,平均14个月,无螺钉断裂,骨折组仅2例 JikeiⅠ级患者固定后五六个月时发生螺钉松动、部分复位矫正丢失等固定不稳,但无明显其他不良影响.骨折组复位矫正丢失平均5%,融合组植骨融合率100%.对于骨质疏松患者,根据骨质梳松程度采用不同的提高螺钉固定稳定性方法,可以减少螺钉松动和复位矫正丢失等固定不稳并发症.
배경:골질소송환자치입추궁근라정후,역발생라정송동화복위교정주실등고정불은현상,인차,골질소송피인위시추궁근라정적상대금기증. 목적:관찰골질소송환자제고추궁근라정은정성방법적림상응용효과. 방법:34례골질소송환자행추궁근라정내고정,술중채용료제고추궁근라정은정성방법.골절환자14례(골절조),골병환자20례.20례골병환자화5례골절환자행척주후외측혹추간식골융합(융합조).골질소송안 Jikei 분급,초급8례,Ⅰ급11례,Ⅱ급8례,Ⅲ급7례.대19례초급화Ⅰ급골질소송환자,채용교조화교장라정,동시결합채용라정여련접봉강직성련접,차유량근횡향련접장치,좌우、상하추궁근라정분별재수평면화시상면이교대성각치입라정등방법제고라정고정상대은정성;대15례Ⅱ급화Ⅲ급골질소송환자,정도주입골수니이제고라정고정절대은정성. 결과여결론:수방9-26개월,평균14개월,무라정단렬,골절조부2례 JikeiⅠ급환자고정후오륙개월시발생라정송동、부분복위교정주실등고정불은,단무명현기타불량영향.골절조복위교정주실평균5%,융합조식골융합솔100%.대우골질소송환자,근거골질소송정도채용불동적제고라정고정은정성방법,가이감소라정송동화복위교정주실등고정불은병발증.
@@@@BACKGROUND: Screw loosening and loss of correction are main complications in patients with osteoporosis receiving pedicle screw implantation. Therefore, osteoporosis is considered as a relative contraindication for pedicle screws. @@@@OBJECTIVE: To study the clinical results of methods for improving stability of pedicle screw in patients with osteoporosis. @@@@METHODS: Thirty-four patients with osteoporosis were treated with pedicle screw internal fixation, and the methods of improving stability of pedicle screw were applied during the operation. There were 14 cases of fractures (fracture group) and 20 cases of osteopathy. Spinal posterolateral or intervertebral body graft fusion was performed in the 20 cases of osteopathy and five cases of fractures (fusion group). According to Jikei grading scale for osteoporosis, eight cases were in early stage, 11 cases Ⅰ stage, eight cases Ⅱ stage and seven cases Ⅲ stage. For 19 cases inearly stage and Ⅰ stage osteoporosis, longer and large size of pedicle screws were used, combined with rod system with ankylosing connection between screws and connecting rods using two cross-link devices, placement of pedicle screw with large angles in the horizontal and the sagittal planes were applied to improve the relative stability of screw. For 15 cases of Ⅱ stage and Ⅲ stage osteoporosis, bone cement was used to fil the screw path to improve the absolute stability of screw. @@@@RESULTS AND CONCLUSION: There was no breakage of screw during the fol ow-up with the mean period of 14 months (ranged 9-26 months), only two cases in fracture group with Jikei Ⅰ stage osteoporosis had screw loosening at 5 to 6 months after fixation, as wel as partial loss of correction of reduction, but no other adverse effects. The loss of correction of reduction in the fracture group was 5% in average, and the fusion rate was 100% in the fusion group. Different methods of improving the stability of pedicle screw applied in patients with osteoporosis according to different situations may reduce the occurrence of complications, such as screw loosening and loss of correction.