两种推杆椎弓钉道骨水泥强化后路椎体间融合比较△（开放获取）

Comparison of two kinds of pushrod in bone cement augmented pedicle screw in posterior lumbar interbody fusion

摘要:

[目的] 探究刻度推杆与无刻度推杆在骨水泥钉道强化术治疗骨质疏松性腰椎退变性疾病中的临床效果。[方法] 回顾性分析2021 年10 月—2022 年10 月本科采用骨水泥增强椎弓钉后路腰椎体间融合治疗骨质疏松性腰椎退变性疾42 例患者的临床资料，依据医患沟通结果，22 例手术过程中使用刻度骨水泥推杆（刻度组），另外20 例不使用刻度骨水泥推杆（无刻度组）。比较两组围术期情况、随访与影像学资料。[结果] 刻度组手术时间[(142.7±53.4) min vs (164.3±58.6) min, P＜0.05]、术中X 线透视次数[(10.2±2.3) 次vs (15.3±1.8) 次, P＜0.05]、术中出血量[(246.6±123.8) ml vs (324.1± 113.8) ml, P＜0.05] 均显著优无刻度组，两组切口总长度、切口愈合等级、下地行走时间和住院时间的差异无统计学意义（P＞0.05）。但是，刻度组的骨水泥渗漏率显著低于无刻度组（4.5% vs 11.3%, P＜0.05）。随访时间平均（13.9±3.2） 个月，两组恢复完全负重活动时间的差异无统计学意义（P＞0.05）。随着时间推移，两组VAS 和ODI 评分显著减少（P＜0.05），相应时间点，两组间VAS 和ODI 评分的差异均无统计学意义（P＞0.05）。影像方面：与术前相比，术后3 个月和末次随访时两组患者腰椎前凸角均显著改善（P＜0.05）。相应时间点两组间腰椎前凸角Cobb 角、Bridwell 融合分级的差异均无统计学意义（P＞0.05）。[结论] 骨质疏松性腰椎退变性疾病行椎间融合时选择骨水泥钉道强化术应用刻度骨水泥推杆，可以减少透视次数、缩短手术时间、降低骨水泥渗漏。

Abstract:

[Objective] To explore the clinical outcomes of posterior lumbar interbody fusion (PLIF) with bone cement augmented pedi-cle screw by graduated or non-graduated pushrods for osteoporotic lumbar degenerative diseases. [Methods] A retrospective study was per-formed on 42 patients who underwent PLIF with bone cement augmented pedicle screw for osteoporotic lumbar degenerative diseases fromOctober 2021 to October 2022. According to doctor-patient communication, 22 patients had the graduated pushrod used for bone cementaugmentation of the pedicle screws, while the other 20 patients had the ungraduated rod used. The perioperative, follow-up and imaging dataof the two groups were compared. [Results] The graduated group proved significantly superior to the ungraduated group in terms of operationtime [(142.7±53.4) min vs (164.3±58.6) min, P＜0.05], intraoperative fluoroscopy times [(10.2±2.3) times vs (15.3±1.8) times, P＜0.05], intra-operative blood loss [(246.6±123.8) ml vs (324.1±113.8) ml, P＜0.05], despite of insignificant differences in total incision length, incisionhealing grade, walking time and hospital stay between the two groups (P＞0.05). In addition, the graduated group got significantly lower bonecement leakage rate than the ungraduated group (4.5% vs 11.3%, P＜0.05). The follow-up period lasted for (13.9±3.2) months in a mean, andthere was no significant difference in time to resume full weight-bearing activities between the two groups (P＞0.05). The VASs and ODIscores decreased significantly over time in both groups (P＜0.05), which were not statistically significant between the two groups at any timepoints accordingly (P＞0.05). Regarding imaging, the lumbar lordosis (LL) significantly improved in both groups 3 months after surgery and atthe last follow-up compared with those preoperatively (P＜0.05). However, there were no significant differences in terms of LL angle andBridwell fusion grade between the two groups at any time points accordingly (P＞0.05). [Conclusion] In the case of lumbar interbody fusionfor osteoporotic lumbar degenerative diseases, the bone cement augmented pedicle screw with the graduated pushrod does reduce the num-ber of fluoroscopy, shorten the operation time and reduce the risk of leakage of bone cement.