椎弓根螺钉骨水泥强化固定治疗腰椎退行性变的临床效果

目的 探讨椎弓根螺钉骨水泥强化固定治疗腰椎退行性变的临床效果.方法 对56例腰椎退行性变患者行椎弓根螺钉骨水泥强化固定、椎间植骨融合,术前测量拟固定椎体的骨密度,术中测量螺钉的最大旋入力偶矩后取出螺钉,钉道注入聚甲基丙烯酸甲酯（PMMA）3ml再次置入螺钉并测量螺钉的最大旋入力偶矩,椎体固定后减压并行椎体间植骨融合.结果 患者均获随访,时间6~24（14.4±3.6）个月,均未发生内固定物松动、断钉及断棒等并发症.影像学评估：骨水泥分布于钉道周围松质骨中无明显椎体外渗.末次随访时按改良Macnab标准评价临床疗效：优27例,良22例,可7例;椎弓根螺钉的最大旋入力偶矩经术中骨水泥强化固定后由（0.61±0.23）N·m增至（1.35±0.32） N·m,差异有统计学意义（P〈0.05）.结论椎弓根螺钉骨水泥强化固定治疗腰椎退行性变可以明显增强螺钉的稳定性.

The clinical observation of augmented pedicle screw fixation with bone cement in the treatment for patients with lumbar degenerative disease

Objective To investigate the clinical effect of augmented pedicle screw fixation with bone cement in the treatment for patients with lumbar degenerative disease. Methods 56 patients with lumbar degenerative disease were treated by pedicle screw fixation with bone cement and posterior lumbar interbody fusion after decompression. Bone density was measured preoperatively and insertional torque was measured before fixation. Pedicle screws were aug- mented with 3ml polymethylmethacrylate（PMMA） and 10 min later insertional torque was measured again. Bone graft and fixation were completed after decompression. Results All cases were followed up for 6 - 24 （ 14. 4 ± 3.6 ） months. There was no complication such as internal fixation loss, broken rod was found. Radiographic assessment the cement was around the trajectories of screws. The clinical outcomes were determined using a modified Macnab criteria, which revealed that 27 patients had excellent results, 22 good, and 7 fair. The insertional torque of pedicle screw had been enhanced from （0. 61 ±0. 23） N. m to （1.35 ±0. 32） N · m after augmented with PMMA. There was significant different （ P 〈 0. 05 ）. Conclusions Augmentation pedicle screw with bone cement of PMMA in the treatment for patients with lumbar degenerative disease can enhance the stability of screw significantly.