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目的:探讨应用多孔中空椎弓根螺钉(cement injectable cannulated pedicle screws,CICPs)骨水泥加强固定治疗合并骨质疏松症的腰椎退变性侧凸的有效性和安全性。方法:回顾性队列研究2014年10月至2015年12月期间北京大学第一医院骨科治疗腰椎退变性侧凸Lenke-silva分级Ⅲ级或Ⅳ级合并骨质疏松症的手术病例,比较多孔中空椎弓根螺钉骨水泥加强固定病例和常规手术病例在腰椎退变性侧凸减压矫形固定融合手术中的临床效果和安全性。术后1个月、6个月和1年各随访一次,采用腰痛视觉模拟评分(visual analog scale,VAS)和下肢痛VAS评定临床症状改善情况,采用Oswestry功能障碍指数(Oswestry disability index,ODI)评分和欧洲五维健康量表(Euro Qol-5 dimensions,EQ-5D)评定术后功能改善情况。拍摄腰椎正侧位X线片、动力位X线片和脊柱全长正侧位X线片,测定冠状位侧弯Cobb角、矢状位胸椎后凸、腰椎前凸Cobb角以及矢状位平衡距离(sagittal vertical axis,SVA),评估手术节段的融合情况。结果:共入组34例病例,其中CICPs组15例,对照组19例,两组病例的一般资料包括年龄、性别比例、体重、身高、体重指数、骨密度T值差异均无统计学意义;CICPs组平均骨水泥加强(5.7±2.2)枚螺钉,手术时间、术中出血量和术中输血量CICPs组高于对照组,但差异无统计学意义。临床效果评定中,两组病例术后1个月、术后6个月、术后1年腰痛VAS评分、下肢痛VAS评分、ODI评分和EQ-5D量表同术前相比均明显降低;组间比较,腰痛VAS评分术后6个月(CICPs组3.1±1.3 vs.对照组4.4±1.4,P<0.01)和术后1年(CICPs组3.3±1.0 vs.对照组5.2±1.4,P<0.01),ODI评分术后1年(CICPs组22.7±17.2 vs.对照组31.4±18.5,P<0.01)和EQ-5D量表术后1年(CICPs组2.9±2.0 vs.对照组3.5±2.5,P<0.01)CICPs组要低于对照组。影像学参数评定中,两组病例腰椎侧凸的冠状位Cobb角术后1个月、术后6个月、术后1年同术前相比均得到明显纠正,矢状位腰椎前凸角和胸椎后凸角术后1个月、术后6个月、术后1年同术前相比较术前均显著增加,组间比较,腰椎侧凸的冠状位Cobb角术后1年CICPs组要明显低于对照组(CICPs组17.6°±6.9°vs.对照组21.2°±7.2°,P<0.01),腰椎前凸角术后6个月(CICPs组-33.5°±8.8°vs.对照组-28.9°±8.3°,P<0.01)和术后1年(CICPs组-33.0°±8.1°vs.对照组-26.3°±7.4°,P<0.01),胸椎后凸角术后1年CICPs组要明显高于对照组(CICPs组26.4°±8.1°vs.对照组22.1°±7.3°,P<0.01)。结论:多孔中空椎弓根螺钉骨水泥加强固定治疗合并骨质疏松的腰椎退变性侧凸安全有效,短期临床效果满意。
Objective: To investigate the effectiveness and safety of cement injectable cannulated pedicle screws (CICPs) in the treatment of degenerative lumbar scoliosis complicated with osteoporosis. METHODS: A retrospective cohort study was performed from October 2014 to December 2015 in the First Hospital of Peking University. Orthopedic treatment of degenerative lumbar sclerosis Lenke-silva class Ⅲ or Ⅳ osteoporosis surgery cases, compared porous hollow vertebra Clinical efficacy and safety of pedicle screw bone cement fixation and routine surgery in lumbar degenerative scoliosis decompression orthopedic fusion surgery. The patients were followed up 1 month, 6 months and 1 year after operation. The visual analogue scale (VAS) and VAS of lower extremity pain were used to evaluate the clinical symptoms. Oswestry disability index (ODI) Score and Euro Qol-5 dimensions (EQ-5D) to assess postoperative functional improvement. Coronal scoliosis Cobb angle, sagittal thoracic kyphosis, lumbar lordosis Cobb angle, and sagittal balance were measured by radiography of posterior lumbar X-ray, dynamic X-ray and full spine X-ray. Distance (sagittal vertical axis, SVA) to evaluate the fusion of surgical segments. Results: A total of 34 cases were enrolled. Among them, 15 cases were in CICPs group and 19 cases were in control group. There was no significant difference in general data including age, sex ratio, body weight, height, body mass index and bone mineral density between two groups. CICPs group average bone cement reinforcement (5.7 ± 2.2) screws, operation time, intraoperative blood loss and intraoperative blood transfusion CICPs group was higher than the control group, but the difference was not statistically significant. In the clinical evaluation, the VAS score, VAS score, ODI score and EQ-5D scale of one month postoperatively, 6 months postoperatively and 1 year postoperatively in both groups were significantly lower than those before operation; The VAS score of lumbago was 6 months after operation (3.1 ± 1.3 in CICPs group and 4.4 ± 1.4 in control group, P <0.01) and 1 year after operation (3.3 ± 1.0 in CICPs group vs 5.2 ± 1.4 in control group, P <0.01). The ODI score was 1 year after surgery (22.7 ± 17.2 in CICPs group vs. 31.4 ± 18.5 in control group, P <0.01) and 1 year after EQ-5D in CICPs group (2.9 ± 2.0 vs. 3.5 ± 2.5, P <0.01) CICPs group was lower than the control group. Imaging parameters in the assessment of two groups of patients with lumbar scoliosis coronal Cobb angle 1 month after surgery, 6 months after surgery, 1 year after surgery were significantly improved compared with preoperative, sagittal lordosis angle And 1 month after thoracic kyphotic angle surgery, 6 months after operation and 1 year after operation were significantly increased compared with those before operation. Compared between the two groups, CBCP of coronal Cobb angle of lumbar scoliosis at 1 year after operation (CICPs group 17.6 ° ± 6.9 ° vs control group 21.2 ° ± 7.2 °, P <0.01), lumbar lordosis 6 months after operation (CICPs group -33.5 ° ± 8.8 ° vs control (-28.9 ° ± 8.3 °, P <0.01) and 1 year after operation (-33.0 ° ± 8.1 ° in CICPs group and -26.3 ° ± 7.4 ° in control group, P <0.01) CICPs group was significantly higher than the control group (CICPs group 26.4 ° ± 8.1 ° vs control group 22.1 ° ± 7.3 °, P <0.01). CONCLUSION: Porous hollow pedicle screw cement augmentation fixation is safe and effective in the treatment of lumbar degenerative scoliosis with osteoporosis. The short-term clinical results are satisfactory.