CAJ | 학술논문

目的探讨老年人胸腰椎椎弓根螺钉内固定术后螺钉松动的原因及预防措施. 方法对2011年5月至2013年5月在我院行胸腰椎椎弓根螺钉内固定手术≥60岁老年患者187例临床资料进行回顾性分析,按是否发生螺钉松动分为松动组和固定良好组,观察并比较两组患者手术时间、出血量、术后6个月及末次随访视觉模拟疼痛评分(VAS)及Oswestry功能障碍指数(ODI)评分,分析螺钉松动的原因. 结果本组行胸腰椎椎弓根螺钉内固定手术主要病因为胸腰椎侧后凸畸形、骨折、滑脱、肿瘤及退行性疾病等,术后平均随访(35.2±8.7)个月.发生内固定松动13例(7.0％),男性5例,女性8例,平均年龄(78.4±3.5)岁.发现螺钉松动时间为术后3～12个月,平均(7.6±3.7)个月.13例患者中,螺钉松动单节段1例,双节段3例,3个或3个以上节段9例.螺钉松动患者中骨质疏松10例.VAS及ODI评分,术后6个月及末次随访与术前比较,差异均有统计学意义(P＜0.05);末次随访与术后6个月比较,差异无统计学意义(P＞0.05).松动组性别及术前骨质疏松患病率与固定良好组比较,差异有统计学意义(P＜0.05). 结论骨质疏松是影响老年患者胸腰椎椎弓根螺钉内固定术后螺钉松动的原因之一,长节段螺钉松动概率增高,可能与老年患者脊柱力学改变有关.对于老年骨质疏松患者,是否需要骨水泥强化治疗,仍需进一步随机对照研究.
목적 탐토노년인흉요추추궁근라정내고정술후라정송동적원인급예방조시. 방법 대2011년5월지2013년5월재아원행흉요추추궁근라정내고정수술≥60세노년환자187례림상자료진행회고성분석,안시부발생라정송동분위송동조화고정량호조,관찰병비교량조환자수술시간、출혈량、술후6개월급말차수방시각모의동통평분(VAS)급Oswestry공능장애지수(ODI)평분,분석라정송동적원인. 결과 본조행흉요추추궁근라정내고정수술주요병인위흉요추측후철기형、골절、활탈、종류급퇴행성질병등,술후평균수방(35.2±8.7)개월.발생내고정송동13례(7.0％),남성5례,녀성8례,평균년령(78.4±3.5)세.발현라정송동시간위술후3～12개월,평균(7.6±3.7)개월.13례환자중,라정송동단절단1례,쌍절단3례,3개혹3개이상절단9례.라정송동환자중골질소송10례.VAS급ODI평분,술후6개월급말차수방여술전비교,차이균유통계학의의(P＜0.05);말차수방여술후6개월비교,차이무통계학의의(P＞0.05).송동조성별급술전골질소송환병솔여고정량호조비교,차이유통계학의의(P＜0.05). 결론 골질소송시영향노년환자흉요추추궁근라정내고정술후라정송동적원인지일,장절단라정송동개솔증고,가능여노년환자척주역학개변유관.대우노년골질소송환자,시부수요골수니강화치료,잉수진일보수궤대조연구.
Objective To explore what cause the screw loosening after the internal fixation with thoracic and lumbar pedicle screws in the elderly and to develop the preventive measures.Methods Retrospective analysis were used to collect the clinical data from patients ager 60 years and over who had undergone surgeries of thoracolumbar pedicle screw internal fixation in our hospital during May 2011 and May 2013.Totally 187 cases were included in this study.According to whether there was a loosening of the screws, patients were divided into fixtion-loose and-well groups.The operation time and blood loss volume in the two groups were recorded.Visual analogue scale (VAS), Oswestry disability index (ODI), the rate of screw loosening were compared at 6 months after operation and the last follow-up.The causes of screw loosening were analyzed.Results The main causes for the thoracic and lumbar pedicle screw internal fixation were thoracolumbar kyphoscoliosis, fractures,spondylolisthesis, cancer and degenerative diseases, etc.Patients were followed up for an average of (35.2±8.7) months.13 patients (7.0％) were found screw loosening, 5 males and 8 females, with the mean age of (78.4 ± 3.5) years.The screw loosening occurred 3 months to 1 year after the surgery, (7.6±3.7) months on average.Among the 13 patients with screw loosening, 1 patient suffered screw loosening in single segment, 3 patients in two segments, and 9 patients in three segments or above.Osteoporosis combined with screw loosening.appeared in 10 patients VAS and ODI scores in all subjects had statistically differences at 6 months after operation and the last follow up versus preoperation (P＜0.05 for all), but no statistical difference versus the last follow-up(P＞ 0.05).There were significant differences in gender and preoperative osteoporosis rate between the two groups (P＜0.05 for both).Conclusions Osteoporosis is one of the reasons for the screw loosening in elderly patients after pedicle screw internal fixation.The increased probability of the screw loosening in long segment may be related with the change of the older spine mechanics.Further randomized controlled trials are still required to confirm whether elderly osteoporosis patients need to receive bone cement augmentation treatment.