CAJ | 학술논문

背景：腰椎退行性病变一旦合并腰椎管狭窄、腰椎失稳及退变性侧凸，引起相应的临床症状需要手术治疗时，不可避免的需要使用内固定器械。骨质疏松在老年人群中相当普遍，因此如何在严重骨质疏松患者的脊柱上置入稳定的椎弓根螺钉内固定系统将是一个很大的难题。近年来有研究证实了骨水泥强化中空侧孔椎弓根螺钉在椎体内的生物力学稳定性，因此成为脊柱外科的关注热点。目的：探讨应用聚甲基丙烯酸甲酯骨水泥强化中空侧孔椎弓根螺钉置入内固定修复伴骨质疏松症的腰椎退变性疾病的疗效。方法：2012年2月至2014年3月江苏大学附属医院骨科共收治伴骨质疏松症的腰椎退行性变患者31例，男11例，女20例；年龄65-86岁，平均73.5岁。其中腰椎管狭窄症14例，腰椎间盘突出症并节段不稳9例，退行性腰椎滑脱症6例，退行性侧凸2例。根据患者症状、体征及影像学资料确定减压、融合节段，采用骨水泥强化中空侧孔椎弓根螺钉系统进行内固定、矫形。采用目测类比评分法对患者内固定前后的疼痛状况进行评估，神经症状缓解情况采用日本骨科学会(JOA)29分法对内固定前和随访时的神经功能和生活能力进行评估。结果与结论：所有病例随访36-48个月，未出现断钉、断棒、椎弓根螺钉拔出、松动、融合节段假关节形成以及切口感染等并发症。内固定后患者腰痛、腿痛目测类比评分及神经症状JOA评分均明显改善(P <0.01)。提示对于伴骨质疏松症的腰椎退行性变患者，应用骨水泥强化型中空侧孔椎弓根螺钉系统置入内固定，能增强螺钉的稳定性，防止螺钉松动、拔出，有助于临床疗效的改善和保持。
배경：요추퇴행성병변일단합병요추관협착、요추실은급퇴변성측철，인기상응적림상증상수요수술치료시，불가피면적수요사용내고정기계。골질소송재노년인군중상당보편，인차여하재엄중골질소송환자적척주상치입은정적추궁근라정내고정계통장시일개흔대적난제。근년래유연구증실료골수니강화중공측공추궁근라정재추체내적생물역학은정성，인차성위척주외과적관주열점。목적：탐토응용취갑기병희산갑지골수니강화중공측공추궁근라정치입내고정수복반골질소송증적요추퇴변성질병적료효。방법：2012년2월지2014년3월강소대학부속의원골과공수치반골질소송증적요추퇴행성변환자31례，남11례，녀20례；년령65-86세，평균73.5세。기중요추관협착증14례，요추간반돌출증병절단불은9례，퇴행성요추활탈증6례，퇴행성측철2례。근거환자증상、체정급영상학자료학정감압、융합절단，채용골수니강화중공측공추궁근라정계통진행내고정、교형。채용목측류비평분법대환자내고정전후적동통상황진행평고，신경증상완해정황채용일본골과학회(JOA)29분법대내고정전화수방시적신경공능화생활능력진행평고。결과여결론：소유병례수방36-48개월，미출현단정、단봉、추궁근라정발출、송동、융합절단가관절형성이급절구감염등병발증。내고정후환자요통、퇴통목측류비평분급신경증상JOA평분균명현개선(P <0.01)。제시대우반골질소송증적요추퇴행성변환자，응용골수니강화형중공측공추궁근라정계통치입내고정，능증강라정적은정성，방지라정송동、발출，유조우림상료효적개선화보지。
BACKGROUND:Once lumbar degenerative diseases merge with lumbar spinal stenosis, lumbar instability and degenerative scoliosis, surgical therapy is required for corresponding clinical symptoms, and the usage of internal fixators cannot be inevitable. Osteoporosis is rather common in the elderly. Therefore, how to implant stable pedicle screw fixation system in serious osteoporosis patients wil be a big difficulty. In recent years, some studies have proven the biomechanical stability of polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw in the vertebral body, so it becomes very hot in the spine surgery. OBJECTIVE: To explore the clinical efficacy of the use of polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw fixation for the treatment of lumbar degenerative disease accompanied with osteoporosis. METHODS:Thirty-one patients with lumbar degenerative disease accompanied with osteoporosis from Jun 2008 to Jan 2013 were selected, including 11 males and 20 females with an average age of 73.5 years (range, 65-86 years). There were 14 cases of lumbar degenerative stenosis, 9 of lumbar intervertebral disc herniation combined with segmental instability, 6 of lumbar degenerative spondylolisthesis, and 2 of lumbar degenerative scoliosis. The patients were treated with lumbar canal decompression, fusion and polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw fixation according to their clinical features and imaging data. Visual analog scale for pain evaluation was used before and after fixation, the Japanese Orthopaedic Association (JOA) scale was used for assessment of neurological function and life skils before internal fixation and during folow-up. RESULTS AND CONCLUSION:Al cases were folowed up for 40 months (range, 36-48months). No screw breakage, rod breakage, screw extraction, loosening, pseudoarticulation formation, or incision infection was found. The postoperative visual analog scale score and the JOA score was remarkably improved (P < 0.05). For patients suffering from lumbar degenerative disease accompanied with osteoporosis, polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw fixation is helpful for increasing the stabilization of screw and preventing from loosening and dislocation of the screws, and thereby beneficial for improvement and maintenance of clinical efficacy.