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目的探究骨水泥强化椎弓根螺钉技术应用于脊柱肿瘤合并邻近椎节骨质量不佳患者术后脊柱稳定性重建的有效性和安全性。方法回顾分析2012年12月至2014年11月,于我科采用骨水泥强化椎弓根螺钉技术治疗脊柱肿瘤合并邻近椎节骨质量不佳的35例患者术后脊柱稳定性重建的临床资料,其中男22例,女13例;年龄40~76岁,平均(58.1±8.5)岁。对术后骨水泥在椎体内的弥散情况及与椎体和螺钉的相对位置行具体探究。结果本组随访时间为14~37个月,平均(28.3±4.6)个月。随访时美国脊髓损伤协会(American spinal cord injury association,ASIA)、视觉模拟疼痛评分(visual analogue scale,VAS)较术前均有显著改善。后凸平均矫正率为54.8%,末次随访平均丢失角为0.6°,侧凸平均矫正率为71%,末次随访平均丢失角为0.3°。术前及术后冠状位Cobb’s角分别为(6.0±6.4)°和(1.5±2.3)°,术前及术后矢状位Cobb’s角分别为(14.1±12.8)°和(11.2±8.1)°,差异均有统计学意义;术后3个月与末次随访冠状位及矢状位Cobb’s角无明显改变。随访复查影像学显示所有患者椎间植骨融合情况良好,未发现手术相关并发症。无内固定失败事件发生。骨水泥多对称分布在螺钉尖端及钉道旁。骨水泥分布于前柱占73.4%,分布于前柱及中柱前部占26.6%。骨水泥弥散-钉道半径比95%CI:1.80~3.14,骨水泥弥散-钉道深度比95%CI:64.6%~92.2%,钉道-骨水泥弥散体积比95%CI:10.1%~40.6%,骨水泥弥散-椎体体积比95%CI:2.0%~20.2%,骨水泥弥散长度-椎体直径比95%CI:43.3%~66.1%。结论骨水泥强化椎弓根螺钉技术可安全有效地实现脊柱肿瘤合并邻近椎节骨质量不佳患者接受病灶切除术后脊柱的稳定性。有助于缓解患者局部疼痛、恢复脊髓神经功能及维持脊柱稳定性。而该内固定方法成功操作的关键在于获得合理的骨水泥弥散分布方式。
Objective To investigate the effectiveness and safety of bone cement-enhanced pedicle screw technique in spinal stabilization reconstructions in patients with spinal tumors and poor quality of adjacent vertebral articular spine. Methods From December 2012 to November 2014, we retrospectively analyzed the clinical data of 35 patients with spine tumor combined with poor stability of the adjacent vertebral arteries treated with bone cement-enhanced pedicle screw fixation from December 2012 to November 2014, Including 22 males and 13 females; aged 40 to 76 years, mean (58.1 ± 8.5) years. The postoperative bone cement dispersion in the vertebral body and the relative position of the vertebral body and screw row specific exploration. Results The follow-up time ranged from 14 to 37 months with an average of (28.3 ± 4.6) months. At follow-up, ASIA and VAS significantly improved compared with that before operation. The mean correction rate of kyphosis was 54.8%, the average follow-up loss was 0.6 °, the average correction rate of scoliosis was 71%, and the average follow-up loss was 0.3 °. Cobb’s angle of preoperative and postoperative coronal were (6.0 ± 6.4) ° and (1.5 ± 2.3) °, and preoperative and postoperative sagittal Cobb’s angle were (14.1 ± 12.8) ° and (11.2 ± 8.1) ° , The differences were statistically significant; 3 months after surgery and the last follow-up coronal and sagittal Cobb’s angle had no significant change. Follow-up imaging studies showed that all patients had good fusion of the interbody fusion and no operative-related complications were found. No internal fixation failure occurred. Bone cement more symmetrical distribution in the screw tip and nail Road. The distribution of bone cement in the anterior column accounted for 73.4%, located in the anterior column and the anterior column accounted for 26.6%. Bone cement diffusion - screw radius ratio 95% CI: 1.80 ~ 3.14, bone cement diffusion - nail depth ratio of 95% CI: 64.6% ~ 92.2%, pinhole - bone cement volume ratio 95% CI: 10.1% ~ 40.6 %, The volume of cement dispersion-vertebral volume 95% CI: 2.0% ~ 20.2%, the length of cement dispersion - vertebral diameter ratio 95% CI: 43.3% ~ 66.1%. CONCLUSION: The cement-enhanced pedicle screw technique can safely and effectively stabilize the spine after spinal excision in patients with spinal tumors and adjacent poor quality of vertebral arteries. Helps relieve local pain, restore spinal cord function and maintain spinal stability. The key to the successful operation of the internal fixation method is to obtain a reasonable dispersion of bone cement.