CAJ | 학술논문

目的：探讨骨水泥强化椎弓根螺钉手术相关并发症发生率，分析其发生原因并提出可能的避免对策。方法回顾性分析2014年2月至2015年2月进行骨水泥强化椎弓根钉植入的手术病例，记录患者一般临床资料并通过X线测量螺钉植入深度（螺钉尖端与椎体后缘距离）与椎体矢状径比值，收集患者围手术期并发症及骨水泥相关并发症发生情况，通过Logistic回归分析并发症发生的影响因素。结果13例手术共75枚骨水泥强化椎弓根螺钉，平均年龄66.85岁，平均体重指数22.65 kg/m2；平均手术时间152.03 min，平均出血量450.00 ml；股骨颈骨密度T值-2.0至-3.6。75枚椎弓根螺钉中9枚骨水泥渗漏（6枚渗漏入椎体周围，3枚渗入血管），渗漏发生率12.00%。椎体周围未渗漏组螺钉拧入深度与椎体椎体矢状径比值平均0.81±0.09，渗漏组比值平均0.62±0.07，两者有显著性差异（ P <0.05）。多因素非条件Logistic回归显示患者BMI、螺钉拧入椎体深度是椎体周围骨水泥渗漏的独立危险因素（ P <0.05），与患者年龄、性别、骨密度结果、手术节段等无关。所有患者均无神经系统损害加重表现。无肺栓塞、猝死等恶性不良事件发生。1例患者出现邻近节段再骨折。短期随访内固定系统无松动、断裂表现。结论骨质疏松患者脊柱后路减压术中行骨水泥强化椎弓根钉内固定近期可以获得可靠的稳定性，手术相关并发症较少，但需要密切关注术中螺钉拧入深度和骨水泥渗漏的发生。
목적：탐토골수니강화추궁근라정수술상관병발증발생솔，분석기발생원인병제출가능적피면대책。방법회고성분석2014년2월지2015년2월진행골수니강화추궁근정식입적수술병례，기록환자일반림상자료병통과X선측량라정식입심도（라정첨단여추체후연거리）여추체시상경비치，수집환자위수술기병발증급골수니상관병발증발생정황，통과Logistic회귀분석병발증발생적영향인소。결과13례수술공75매골수니강화추궁근라정，평균년령66.85세，평균체중지수22.65 kg/m2；평균수술시간152.03 min，평균출혈량450.00 ml；고골경골밀도T치-2.0지-3.6。75매추궁근라정중9매골수니삼루（6매삼루입추체주위，3매삼입혈관），삼루발생솔12.00%。추체주위미삼루조라정녕입심도여추체추체시상경비치평균0.81±0.09，삼루조비치평균0.62±0.07，량자유현저성차이（ P <0.05）。다인소비조건Logistic회귀현시환자BMI、라정녕입추체심도시추체주위골수니삼루적독립위험인소（ P <0.05），여환자년령、성별、골밀도결과、수술절단등무관。소유환자균무신경계통손해가중표현。무폐전새、졸사등악성불량사건발생。1례환자출현린근절단재골절。단기수방내고정계통무송동、단렬표현。결론골질소송환자척주후로감압술중행골수니강화추궁근정내고정근기가이획득가고적은정성，수술상관병발증교소，단수요밀절관주술중라정녕입심도화골수니삼루적발생。
Objective To explore and analyze the surgery related complications of PMMA cement-augmented pedicle screws. Methods 13 patients underwent posterior spinal decompression and PMMA cement-augmented pedicle screws instrumentation were retrospectively ana-lyzed. The clinical data of patients including the age,sex,BMI,BMD,operative time and bleeding,the depth of the screws in the vertebral and the cement leakage of each screw were recorded. We analyzed the risk factors leading to cement leakage by Logistic regression. Results 13 osteo-porotic patients(a total of 75 cannulated pedicle screws with cement augmentation,with mean age of 66. 85 years)were enrolled in this study. The range of BMD T-score in femoral neck site of all patients was from -2. 0 to -3. 6. The cement leakage rate was 12. 00%(9/75). The ra-tio of the depth of the screws in the vertebral and the vertebral sagittal diameter was 0. 81 in the group without intraoperative cement leakage,while 0. 62 in the group with cement leakage. The depth of the screws in the vertebral and BMI were risk factors of cement leakage. One patient had a postoperative adjacent vertebral fracture. Conclusion Posterior spinal decompression using PMMA cement-augmented pedicle screws instrumen-tations for osteoporotic patients can get satisfied fixed effects with good safety. However,we should pay close attention to the depth of the screws in the vertebral and the occurrence of cement leakage during surgery.