可注射骨水泥椎弓根螺钉在骨质疏松症脊柱内固定手术应用中的中长期临床疗效评估

汪正东; 代飞; 刘瑶瑶; 荣志刚; 王成; 刘勋; 张飞; 许建中

doi:10.16016/j.1000-5404.201804100

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可注射骨水泥椎弓根螺钉在骨质疏松症脊柱内固定手术应用中的中长期临床疗效评估

临床医学 | 更新时间：2026-01-09

- 可注射骨水泥椎弓根螺钉在骨质疏松症脊柱内固定手术应用中的中长期临床疗效评估
- Bone cement-injectable cannulated pedicle screw augmented with polymethylme-thacrylate in osteoporotic spine: a mid- and long-term clinical efficacy of 128 cases
- 第三军医大学学报 2018年40卷第19期页码：1777-1783
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院骨科，全军矫形外科中心
- 作者简介：
  
  [ 许建中，E-mail:xngkxjz@sina.com XU Jianzhong, E-mail: xngkxjz@sina.com
- 基金信息：
  
  第三军医大学临床创新基金(SWH2013LC14)
- DOI：10.16016/j.1000-5404.201804100
  中图分类号： R681.5+5;R683.2;R687.3+2
- 收稿：2018-04-16，
  
  修回：2018-05-10，
  
  纸质出版：2018-10-15
- 稿件说明：
移动端阅览
汪正东, 代飞, 刘瑶瑶, 等. 可注射骨水泥椎弓根螺钉在骨质疏松症脊柱内固定手术应用中的中长期临床疗效评估[J]. 第三军医大学学报, 2018,40(19):1777-1783.

Zhengdong WANG, Fei DAI, Yaoyao LIU, et al. Bone cement-injectable cannulated pedicle screw augmented with polymethylme-thacrylate in osteoporotic spine: a mid- and long-term clinical efficacy of 128 cases[J]. Journal of Third Military Medical University, 2018, 40(19): 1777-1783.
汪正东, 代飞, 刘瑶瑶, 等. 可注射骨水泥椎弓根螺钉在骨质疏松症脊柱内固定手术应用中的中长期临床疗效评估[J]. 第三军医大学学报, 2018,40(19):1777-1783. DOI： 10.16016/j.1000-5404.201804100.

Zhengdong WANG, Fei DAI, Yaoyao LIU, et al. Bone cement-injectable cannulated pedicle screw augmented with polymethylme-thacrylate in osteoporotic spine: a mid- and long-term clinical efficacy of 128 cases[J]. Journal of Third Military Medical University, 2018, 40(19): 1777-1783. DOI： 10.16016/j.1000-5404.201804100.

摘要

目的

评价可注射骨水泥椎弓根螺钉(bone cement-injectable cannulated pedicle screw，CICPS)在骨质疏松症(osteoporosis，OP)脊柱手术应用中的中长期安全性及有效性。

方法

本科2011年3月至2015年3月收治OP患者128例，均应用CICPS进行脊柱内固定手术。术前进行腰腿痛视觉模拟评分法(Visual Analogue Scale/Score

VAS)评分、Oswestry功能障碍指数问卷表(ODI)评分，行X线、CT、MRI检查进行影像学评估。术后即刻(术后1周内)复查X线片，术后1、3、6、12个月及以后每年定期随访，统计各个随访节点各指标[临床指标：腰痛VAS评分、腿痛VAS评分、ODI评分；影像学指标：椎体高度、椎间隙高度、滑脱角、Taillard指数、螺钉位移情况(钉尖至椎体前缘及上终板的距离，分别记为x

y)、融合率；并发症情况：骨水泥渗漏情况、血管栓塞、肺栓塞

]

，并与术前、术后即刻进行对比分析，采用SPSS 18.0统计软件，对符合正态分布变量的进行配对

检验。评估患者临床症状、影像学检查、并发症等情况。

结果

病例均获随访，随访时间23~71(42.4±13.4)个月。共使用418枚CICPS，术中及随访过程中共发现27枚螺钉发生骨水泥渗漏(约占6.46%)，均未发现任何临床并发症。末次随访腰腿痛VAS评分、ODI指数均明显低于术前(

0.05)，末次随访螺钉位置较术后即刻无明显移位(

0.05)，且均获骨性融合，无一例翻修病例。术后未发生感染及血栓形成。

结论

骨水泥强化的CICPS应用于OP脊柱内固定手术安全、有效。

Abstract

Objectives

To evaluate the mid- and long-term safety and efficacy of a novel bone cement-injectable cannulated pedicle screw (CICPS) augmented with polymethylmethacrylate (PMMA) in osteoporotic spinal surgery.

Methods

A total of 128 osteoporosis patients who underwent spinal instrumentation with PMMA-augmented CICPS in our department from March 2011 to March 2015 were enrolled in this study. Postoperative Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were carried out preoperatively. Postoperative plain radiography and CT scanning were performed immediately after surgery. All the patients were followed up at 1

6 and 12 months

and annually thereafter. Their clinical parameters (VAS scores for low back and leg pains and ODI score)

radiological indexes [vertebral height

intervertebral space height

slip angle

Taillard index

fusion rate and screw displacement (distance from screw tip to anterior edge of vertebral body and upper endplate)]

complications (bone cement leakage

vascular embolism and pulmonary embolism) were observed and measured

and the results at pre-operation and immediate post-operation were compared with the aid of SPSS 18.0 statistics.

Results

All patients were followed up for a mean time of 42.4±13.4 months (23 to 71 months).A total of 418 PMMA-augmented CICPS were used

but cement extravasations were only found in 27 CICPS (6.46%)

and caused no clinical sequela. The low back and lower limb VAS scores and ODI scores at the final follow-up were significantly lower than those of pre-operation (P < 0.05). No significant screw displacement was found at the final follow-up when compared with immediately after surgery (P < 0.05). All cases got successful bone fusion and no one needed revision. No infection and blood clots occurred after surgery.

Conclusion

The PMMA-augmented CICPS is safe and effective for osteoporotic patients who require spinal instrumentation.

关键词

Keywords

references

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