使用PMMA人工骨泥增強椎弓根螺釘內固定手術治療骨質疏鬆性脊柱疾病之成效

研究目的：本回顧性研究旨在評估使用PMMA人工骨泥增強椎弓根螺釘內固定治療骨質疏鬆並合併退行性脊柱疾病的患者使用該新方法後疼痛和脊柱殘疾的發生率。研究方法及資料：在2013年1月1日至2015年12月31日期間，36位退行性脊柱疾病和骨質疏鬆症患者（T-score < -2.5)使用水泥可注射插管椎弓根螺釘進行腰椎融合。使用Visual Analog Scale (VAS)和Oswestry Disability Index (ODI)評估臨床結果。 患者在3個月和12個月後進行放射學追蹤檢查，此後每年進行一次檢查。分析方法以IBM SPSS 統計 24.0 版本進行了分析。進行配對t檢定來比較連續變量，包括術前和最後的VAS和ODI分數。 p值小於0.05是認為很有顯著意義。研究結果：評估納入了36名患者，其中男性5名，女性31名，所有患者的平均追蹤時間為24.8個月，平均骨密度（BMD）T-score為-2.96±0.80。患者的平均年齡是67.6歲（範圍，52-82）。術前VAS評分（7.33±1.17），高於術後三個月VAS（2.19±0.52）和術後一年VAS（3.39±1.25），差異有統計學意義（p< 0.001，p< 0.001）。術前Oswestry殘疾指數評分(81.78±9.46) ，低於術後一年Oswestry殘疾指數（38.44±14.89），差異有統計學意義(p< 0.001）。每節椎體螺釘注射的水泥的平均量為4.08± 0.25mL。1例患者發生椎弓根螺釘鬆動（2.78％），該患者在這種情況下進行了延長背架使用及骨質疏鬆藥物Forteo使用，一年後追蹤骨融合良好。結論與建議：所描述的使用骨水泥注射式插管式椎弓根螺釘的聚甲基丙烯酸甲酯(PMMA)增強技術可減輕骨質疏鬆症患者接受骨質疏鬆脊柱手術中的疼痛並改善脊柱功能障礙。

Objective：This retrospective study was designed to evaluate the incidence of pain and spine disability after the use of this new method in patients treated with PMMA-enhanced cannulated screw fixation for osteoporosis combined with degenerative spinal disease.Methods and Materials：Between January 1, 2013 and December 31, 2015, lumbar fusion was performed using cement-injectable cannulated pedicle screws in 36 patients with degenerative spinal disease and osteoporosis (T-score < -2.5).Clinical results were assessed using the Visual Analog Scale and the Oswestry Disability Index. The patients underwent radiological follow-up at 3 months and 12 months, and then examined once a year thereafter.The analysis method was analyzed with IBM SPSS Statistics 24.0 . A paired t-test was performed to compare continuous variables, including preoperative and final VAS and ODI scores. A p value less than 0.05 is considered significant.Results：Thirty-six patients were evaluated and included, 5 males and 31 females with an average bone mineral density (BMD) T-score of -2.96±0.80. The average follow-up time for all patients was 24.8 months. The average age of the patients was 67.6 (range, 52-82). The preoperative VAS for low back and leg pain (7.33±1.17) was higher as compared with postoperative 3 months VAS(2.19±0.52）and postoperative 1 year VAS（3.39±1.25）with statistical significance (p< 0.001, p< 0.001).The preoperative ODI (81.78±9.46) was lower as compared with postoperative 1 year ODI(38.44±14.89）with statistical significance (p< 0.001). Radiological observations showed no new screws or prolapse, and bone fusion was good..Conclusion and Suggestion：The described polymethyl methacrylate (PMMA) augmentation technique using a bone cement injection intubation pedicle screw can reduce pain in spinal osteoporosis patients undergoing osteoporosis and improve spinal dysfunction.