直入式注入聚甲基丙烯酸甲酯骨水泥强化椎弓根钉内固定治疗骨质疏松性胸腰椎骨折

目的 探讨应用直入式注入聚甲基丙烯酸甲酯(PMMA)骨水泥强化椎弓根钉内固定治疗骨质疏松性胸腰椎骨折的疗效.方法 2009年1月至2010年2月应用直入式注入PMMA骨水泥强化椎弓根钉内固定治疗14例骨质疏松性胸腰椎骨折患者,男9例,女5例;年龄50～72岁,平均61岁.临床疗效采用视觉模拟(VAS)疼痛评分、Frankel分级方法进行评定,应用X线片评估术后内固定效果.结果 14例患者中13例术后获6～22个月(平均18.4个月)随访,1例失访.VAS评分由术前平均7.9分降至术后平均1.2分,7例合并有神经损伤的患者Frankel分级术后平均改善1.2级,58枚椎弓根钉中54枚行直入式注入PMMA骨水泥强化,术后所有患者均未出现与骨水泥渗漏相关的神经损伤症状和体征.X线片示椎弓根螺钉未发生松动及脱出,周围无透亮线出现.后凸角由术前平均21.8°改善至术后平均10.3°,末次随访后凸角平均为14.3°,平均后凸角矫正丢失40°.结论 应用直入式注入PMMA骨水泥强化椎弓根钉内固定治疗骨质疏松性胸腰椎骨折可获得满意的临床疗效.

Abstract：

Objective To explore clinical outcomes of direct injection of polymethylmethacrylate (PMMA) to augment pedicle screw fixation for osteoporotic thoracolumbar fractures. Methods From January 2009 to February 2010, 14 patients with osteoporotic thoracolumbar fracture underwent spinal decompression and instrumentation with PMMA augmentation of pedicle screw by direct injection. They were 9 men and 5 women, aged from SO to 72 years (average, 61 years). The clinical outcomes were evaluated by the visual analog scale (VAS) and the Frankel scale. Radiologic findings were documented to assess postoperative internal fixation. Results All but one of the patients obtained a mean follow-up of 18. 4 months (from 6 to 22 months). The mean VAS scores of the patients improved from 7. 9 to 1. 2 points (P < 0. 01). Postoperatively, Frankel grading for the 7 patients with neurologic deficit improved by 1. 2 grades. Totally 54 of the 58 screws were augmented with PMMA. There was neither neurologic deterioration nor symptomatic cement leakage after surgery. X-ray plain films revealed no screw loosening, pullout or bright lines around screws. On average,kyphotic deformity was improved from 21. 8° preoperatively to 10. 3° postoperatively (P <0. 01), and returned to 14. 3° at the final follow-up. The average loss of kyphosis correction was 4°. Conclusion Pedicle screw fixation after vertebral augmentation with PMMA by direct injection can gain a satisfactory clinical outcome for patients with osteoporotic thoracolumbar fracture.

Direct injection of polymethylmethacrylate to augment pedicle screw fixation for osteoporotic thoracolumbar fractures

Objective To explore clinical outcomes of direct injection of polymethylmethacrylate (PMMA) to augment pedicle screw fixation for osteoporotic thoracolumbar fractures. Methods From January 2009 to February 2010, 14 patients with osteoporotic thoracolumbar fracture underwent spinal decompression and instrumentation with PMMA augmentation of pedicle screw by direct injection. They were 9 men and 5 women, aged from SO to 72 years (average, 61 years). The clinical outcomes were evaluated by the visual analog scale (VAS) and the Frankel scale. Radiologic findings were documented to assess postoperative internal fixation. Results All but one of the patients obtained a mean follow-up of 18. 4 months (from 6 to 22 months). The mean VAS scores of the patients improved from 7. 9 to 1. 2 points (P < 0. 01). Postoperatively, Frankel grading for the 7 patients with neurologic deficit improved by 1. 2 grades. Totally 54 of the 58 screws were augmented with PMMA. There was neither neurologic deterioration nor symptomatic cement leakage after surgery. X-ray plain films revealed no screw loosening, pullout or bright lines around screws. On average,kyphotic deformity was improved from 21. 8° preoperatively to 10. 3° postoperatively (P <0. 01), and returned to 14. 3° at the final follow-up. The average loss of kyphosis correction was 4°. Conclusion Pedicle screw fixation after vertebral augmentation with PMMA by direct injection can gain a satisfactory clinical outcome for patients with osteoporotic thoracolumbar fracture.