| 张诗爽,魏梦诚,蔡磊,等.骨水泥强化椎弓根螺钉治疗多节段腰椎退行性疾病伴严重骨质疏松症的中期疗效.骨科,2025,16(2): 109-114. |
| 骨水泥强化椎弓根螺钉治疗多节段腰椎退行性疾病伴严重骨质疏松症的中期疗效 |
| The mid-term efficacy of cement-augmented pedicle screw in the treatment of multilevel lumbar degeneration disease with severe osteoporosis |
| 投稿时间：2024-10-14 |
| DOI：10.3969/j.issn.1674-8573.2025.02.003 |
| 中文关键词: 骨水泥 椎弓根螺钉 多节段腰椎退行性疾病 骨质疏松症 |
| 英文关键词: Bone cement Pedicle screws Multi-segmental lumbar degeneration disease Osteoporosis |
| 基金项目:武汉市知识创新专项项目（2023020201020550）；武汉市医学科学研究项目（WX23Q05） |
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| 中文摘要: |
| 目的 评估骨水泥强化椎弓根螺钉（cement-augmented pedicle screw，CAPS）治疗多节段腰椎退行性疾病（multi-segmental lumbar degeneration disease，MLDD）伴严重骨质疏松症（osteoporosis，OP）的中期疗效。方法 对2018年1月至2023年5月于武汉市第四医院就诊的101例MLDD伴严重OP的老年病人进行回顾性研究。基于术式的差异，将病人分为CAPS组（48例）和对照组（传统椎弓根螺钉固定，53例）。评估指标包括病人的年龄、身体质量指数（BMI）、手术时间、术中出血量、术后引流量、骨密度、视觉模拟量表（VAS）评分、腰椎Oswestry功能障碍指数（ODI）、螺钉内固定状况、椎间植骨融合情况及术后并发症的发生率。结果 101例病人均成功实施了腰椎后路手术，随访12~18个月。两组病人术中出血量、术后引流量未见明显统计学差异（P＞0.05）。CAPS组手术时间较对照组长（P＜0.05）。与术前相比，两组病人术后1、3、6个月及末次随访的VAS评分和ODI均有显著改善（P＜0.05）；且CAPS组术后1个月、3个月的VAS评分和ODI均较对照组明显降低（P＜0.05）。术后3 d，腰椎X线影像显示，CAPS组骨水泥未见明显渗漏现象。在随访期间，CAPS组病人未出现螺钉松动或断裂等情况；对照组出现10例螺钉松动，2例延迟愈合。两组病人的椎间植骨融合情况无显著差异（P＞0.05）。结论 对于患有严重骨质疏松性MLDD的病人，CAPS技术能显著提高螺钉固定的稳定性，有效缓解术后疼痛，促进早期下床活动，并促进腰椎功能的迅速恢复。 |
| 英文摘要: |
| Objective To evaluate the mid-term clinical efficacy of cement-augmented pedicle screw (CAPS) in the treatment of multi-segmental lumbar degeneration disease (MLDD) with severe osteoporosis (OP). Methods From January 2018 to May 2023, a retrospective study of 101 elderly patients with MLDD and severe OP were performed in Wuhan Fourth Hospital. The patients were divided into CAPS group (48 cases) and control group (traditional pedicle screw fixation, 53) based on the differences in intraoperative surgical procedures. The patient's age, body mass index (BMI), operation time, intraoperative blood loss, postoperative drainage, bone mineral density, visual analogue scale (VAS) score, Oswestry disability index (ODI), screw internal fixation, interbody fusion and the incidence of postoperative complications were evaluated. Results All 101 patients were successfully treated with posterior lumbar surgery, and were followed up for 12-18 months. There was no significant difference in intraoperative blood loss, postoperative drainage between the two groups (P＞0.05). The operation time of CAPS group was longer than that of control group (P＜0.05). Compared with pre-operation, the VAS score and ODI of the two groups showed significant improvement after operation (P＜0.05). VAS score and ODI in CAPS group were significantly decreased compared to control group at 1 month and 3 months after operation (P＜0.05). At 3 days after operation, the X-ray images of lumbar spine showed that there was no obvious leakage of bone cement in the CAPS group. During the follow-up period, no screw loosening or breakage occurred in the CAPS group, and in the control group, there were 10 cases of screw loosening and 2 cases of delayed union. There was no significant difference in intervertebral bone graft fusion between the two groups (P＞0.05). Conclusion For patients with severe osteoporotic MLDD, CAPS technique can significantly improve the stability of screw fixation, effectively relieve postoperative pain, promote early ambulation, and promote rapid recovery of lumbar function. |
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