【摘要】：背景:研究認為膨脹式椎弓根螺釘抗旋能力強,可以很好的預(yù)防螺釘松動、拔出,維持腰椎穩(wěn)定性、保持其生理曲度,為遠期椎體間融合提供一個安全穩(wěn)定的環(huán)境。目的:探討膨脹式椎弓根螺釘與普通椎弓根螺釘治療骨質(zhì)疏松性腰椎滑脫癥的差異。方法:合并骨質(zhì)疏松的腰椎滑脫癥患者共67例分為保守組12例、膨脹式椎弓根螺釘組20例、普通椎弓根螺釘組35例。3組采集入院時、入院后1周、出院后6個月、出院后12個月、出院后24個月的目測類比評分和JOA評分及影像學(xué)資料,對螺釘穩(wěn)定性、脊柱融合情況進行評估,參考Meyerding滑脫分級標(biāo)準(zhǔn)評估椎體的滑脫情況。結(jié)果與結(jié)論:(1)末次隨訪時JOA改善率:膨脹式椎弓根螺釘組與普通椎弓根螺釘組相比較差異無顯著性意義(P=1.00),均顯著高于保守組(P均0.05);(2)目測類比評分:膨脹式椎弓根螺釘組與普通椎弓根螺釘組均顯著降低,兩組間比較差異無顯著性意義(P0.05),而保守治療組目測類比評分時高時低,反復(fù)變化;(3)滑脫復(fù)位率:膨脹式椎弓根螺釘組明顯高于普通椎弓根螺釘組(P0.01);(4)內(nèi)固定后24個月脊柱融合評分:膨脹式椎弓根螺釘組明顯高于普通椎弓根螺釘組(P=0.035);(5)結(jié)果說明:對于合并骨質(zhì)疏松的腰椎滑脫患者,采用膨脹式椎弓根螺釘固定在滑脫復(fù)位、植骨融合率、螺釘穩(wěn)定性等方面都明顯優(yōu)于普通椎弓根螺釘,此方法更加安全有效。
[Abstract]:Background: it is considered that the expansion pedicle screw has strong anti-rotation ability, which can prevent screw loosening, pull out, maintain the stability of lumbar vertebrae, maintain its physiological curvature, and provide a safe and stable environment for long-term interbody fusion. Objective: to investigate the difference of the treatment of osteoporotic lumbar spondylolisthesis with expansion pedicle screw and common pedicle screw. Methods: 67 cases of lumbar spondylolisthesis complicated with osteoporosis were divided into conservative group (n = 12), expansion pedicle screw group (n = 20) and common pedicle screw group (n = 35). The visual analogue score, JOA score and imaging data were evaluated 12 months after discharge and 24 months after discharge. The screw stability and spinal fusion were evaluated. The spondylolisthesis was evaluated according to Meyerding criteria. Results and conclusion: (1) the improvement rate of JOA at the last follow-up: there was no significant difference between the expansion pedicle screw group and the common pedicle screw group (P0. 00), which were significantly higher than that in the conservative group (P0. 05); (2). Both the screw group and the common pedicle screw group were significantly lower than those in the common pedicle screw group. There was no significant difference between the two groups (P0.05), but the visual analogue score of conservative treatment group was higher than that of control group. (3) reduction rate of spondylolisthesis: the spinal fusion score of the expansion pedicle screw group was significantly higher than that of the common pedicle screw group (P0.01); (4) 24 months after internal fixation: the expansion pedicle screw group was significantly higher than the common pedicle screw group (P0. 035); (5). For lumbar spondylolisthesis with osteoporosis, Expansion pedicle screw fixation was superior to the common pedicle screw in slippage reduction, bone graft fusion rate and screw stability. This method was more safe and effective.
【作者單位】： 重慶醫(yī)科大學(xué)附屬永川醫(yī)院骨科;
【基金】：重慶醫(yī)科大學(xué)附屬永川醫(yī)院資助項目(YJLCX201540)~~
【分類號】：R580;R687.3
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本文編號：2184611