膨胀式椎弓根螺钉在骨质疏松患者腰椎短节段固定融合手术中的临床应用

发布时间：2018-01-29 18:42

  本文关键词： 骨质疏松症 腰椎融合术 椎弓根螺钉　出处：《中国脊柱脊髓杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的:分析膨胀式椎弓根螺钉在骨质疏松患者腰椎短节段固定融合手术中应用的中期疗效。方法:回顾性分析2007年1月~2013年7月行腰椎后路固定融合术且获得3年以上随访资料的患者406例,其中男147例,女259例,年龄50~79岁(63.4±4.2岁),术前腰椎骨密度T值为-3.3±0.6(-2.5~-4.6)。根据术中使用椎弓根螺钉种类的不同,分为膨胀式椎弓根螺钉(EPS)组(n=173)和普通椎弓根螺钉(CPS)组(n=233)。两组患者的性别构成、术前骨密度T值、疾病类型、随访时间均无统计学差异(P0.05)。术前、术后3个月、术后6个月及末次随访时采用VAS和Oswestry功能障碍指数(Oswestry disability index,ODI)进行评价。根据术后每次随访时拍摄的X线片或CT情况,比较两组患者的脊柱融合率、螺钉松动率及断钉情况。结果:所有患者随访时间为3~8年(3.7±1.0年)。两组患者术前VAS评分和ODI评分均无统计学差异(P0.05);两组术后3个月、6个月和末次随访时的VAS评分和ODI评分均较术前显著改善(P0.05);术后3个月、6个月和末次随访时,EPS组患者VAS评分及ODI评分均明显低于CPS组(P0.05)。EPS组中,1例(0.6%,1/173)患者的2枚(0.3%,2/796)螺钉出现松动,5例(2.9%,5/173)患者的7枚(0.9%,7/796)螺钉出现断裂;CPS组中,13例(5.6%,13/233)患者的17枚(1.8%,17/960)螺钉出现松动,2例(0.9%,2/233)患者的4枚(0.4%,4/960)螺钉出现断裂。EPS组螺钉松动率显著低于CPS组(P0.05),螺钉断裂率与CPS组比较无统计学差异(P0.05)。EPS组融合成功率(99.4%,172/173)显著高于CPS组(93.6%,218/233)(P0.05)。结论:在骨质疏松患者腰椎短节段固定融合手术中,使用膨胀式椎弓根螺钉相比普通椎弓根螺钉具有更低的螺钉松动率和更高的脊柱融合率,是一种安全可靠的手术方案。
[Abstract]:Objective: to analyze the curative effect of middle expansive pedicle screw surgery in patients with osteoporosis and lumbar fusion in short segment fixation. Methods: a retrospective analysis of 406 cases of patients with posterior lumbar ~2013 January 2007 July arthrodesis and followed up more than 3 years of data, of which 147 cases were male, 259 were female, aged 50~79 years (63.4. At the age of 4.2), preoperative lumbar bone mineral density T value is -3.3 + 0.6 (-2.5~-4.6). According to the use of pedicle screw type patients were divided into expandable pedicle screw (EPS) group (n=173) and conventional pedicle screw (CPS) group (n= 233). The two groups of patients with gender, preoperative bone mineral density T value, the type of disease, there was no significant difference of follow-up time (P0.05). Before surgery, 3 months after surgery, 6 months after operation and the last follow-up of the VAS and Oswestry disability index (Oswestry disability index, ODI) were evaluated. According to the shooting time at the follow-up of X 绾跨墖鎴朇T鎯呭喌,姣旇緝涓ょ粍鎮ｈ，

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