钉道骨水泥强化植骨融合治疗退行性腰椎侧凸

目的评价钉道骨水泥强化内固定矫形加植骨融合治疗伴骨质疏松及滑脱的腰椎退行性侧凸的中短期疗效。方法2006年6月至2011年3月采用腰椎管减压、椎间植骨和钉道骨水泥强化椎弓根螺钉内固定治疗伴骨质疏松及滑脱的腰椎退行性侧凸患者26例。根据x线片观察术前及术后即刻、2周、3个月、1年腰椎滑脱率、腰椎生理前凸角及椎间隙高度变化，植骨融合情况；采用JOA下腰痛评分标准评价临床疗效。结果26例患者随访12-45个月，平均2年。所有患者症状减轻，JOA评分术前平均13．2分，术后随访时平均27．0分，改善率平均87．5％。术后X线片复查，所有融合椎节均获得骨性融合。腰椎侧凸Cobb角从术前平均26．6°至术后平均11．2°。融合椎间隙高度术后均明显改善，从术前平均0．14cm改善至术后平均0．45cm。术后3个月、1年复查x线片内置物无松动及断裂，滑脱不同程度纠正，植骨融合时间平均12．2周。结论对合并骨质疏松及滑脱的腰椎退行性侧凸患者，钉道骨水泥强化内固定矫形加植骨融合可有效纠正侧凸，手术前对减压、固定范围、畸形矫正与否作出明确的判断，可减少神经并发症的发生。

Clinical Analysis of Pedicle Screw Fixation with Bone Cement Augmentation and Intervertebral Fu- sion in the Treatment of Degenerative Lumbar Scoliosis

Objective To observe the short and mid - term clinical effect of pedicle screw fixation with bone cement aug- mentation and intervertebral fusion in the treatment of degenerative lumbar scofiosis patients with osteoporosis and spondylolis- thesis. Methods From June 2006 to March 2009,26 patients with degenerative lumbar scoliosis and osteoporosis and spon- dylolisthesis were treated by posterior decompression, intervertebral fusion and correction instrumented with pedicle screw fixa- tion with bone cement augmentation. The clinical results were investigated by measuring radiographic measurements, including Taillard index, slipping angle, lumbar lordosis angle, intervertebral height index and JOA scoring preoperatively, immediately, 2 weeks,3 months andl2months postoperatively, respectively. SUK criteria was used to judge bone graft fusion. Results 26 pa- tients were followed up from 12 to 45 months. The clinical symptoms were reduced in all patients. According to the JOA sco- ring：The JOA score was 13.2 for pre -operation and 27.0 for the latest follow -up with the average improve rate of 87.5%. M1 patients obtained solid fusion and their Cobb angle were corrected from 26.6 pre - operation to 11.2 at the followed up pe- riod. The intervertebral height was improved from 0.14 cm pre - operation to 0.45 cm at the followed up period. Spondylolis- thesis were corrected in some degree. The average solid arthrodesis time was 12.2 weeks. Conclusion The surgical technique of pedicle screw fixation with bone cement augmentation and intervertebral fusion is an effective method for treatment of degen- erative lumbar scoliosis patients with osteoporosis and spondylolisthesis. In order to reduce nerve complications,it is very im- portant and necessary to analyze and select the range of decompression, fusion, pedicle screw fixation and deformity correction before operation.