钉道强化技术治疗合并骨质疏松腰椎管狭窄症的临床对照研究

目的：探讨聚甲基丙烯酸甲酯（PMMA）钉道强化技术治疗合并骨质疏松腰椎管狭窄症的安全性及临床预后。方法：选取我院2011年1月～2012年1月收治的腰椎管狭窄症合并骨质疏松的患者47例，分为A、B两组，A组行责任节段减压，PMMA钉道强化，植骨融合内固定术。B组行双皮质固定，责任节段减压，植骨融合内固定术。采用VAS评分，ODI评分，和sF一36评分评估术后的临床疗效，并观察两组术中、术后并发症，及内固定松动情况。结果：所有患者均获得随访，平均随访19．7月（18—30月）。A、B两组比较手术时间、出血量无明显差异（P〉0．05），固定节段A组短于B组，有显著性差异（P〈0．05）。两组术后下肢痛VAS评分，ODI评分，SF-36评分较术前均有明显好转，有显著性差异（P〈0．05）。术后ODI评分和SF-36评分组间比较有显著性差（P〈0．05）。A组中无一例螺钉松动，B组中3例发生螺钉松动，其中2例假关节形成。结论：对于合并骨质疏松的腰椎管狭窄症，PMMA钉道强化技术安全、可靠，较双皮质固定技术固定节段短，能够很好的重建脊柱的稳定性。实际操作中，不会明显增加相关并发症。

The clinical control study of PMMA augmented pedicle screw fixation for lumbar spinal stenosis combined with osteoporosis

Objective： To explore the safety and clinical efficacy of PMMA augmented pedicle screw fixation for treatment of lumbar spinal stenosis combined with osteoporosis. Methods： From January 2011 to January 2012, 47 patients with lumbar spinal stenosis combined with osteoporosis were selected in our hospital. They were divided into group A and B. Patients in group A underwent responsibility segmental decompression, PMMA augmented pedicle screw fixation and bone grafting. Patients in group B underwent responsibility segmental decompression, dual cortex fixation and bone grafting. The clinical efficacy was evaluated by VAS score, ODI score and SF-36 score. The status of intraoperative and postoperative complications and internal fixation loosening was observed. Results： All patients were followed up for an average time of 19.7 months （range 18-30 months）. Between group A and B, there was no significant difference in operation time and blood loss （P＇~O.05）, but was a significant difference in post-op VAS score, ODI score and SF-36 score （P〈0.05）. The number of fixed segment of group A was less than group B with a significant difference （P〈0.05）. No screw loosening was noted in group A, but happed in 3 cases of group B, and 2 of 3 patients had pseu- darthrosis. Conclusion： For lumbar spinal stenosis combined with osteoporosis, PMMA augmented pedicle screw fixation has an advantage of safe, reliable, less complications and better spinal stability. And the length of segment fixation is shorter than dual cortical fixation.