长节段椎弓根螺钉矫形术固定治疗退变性腰椎侧凸伴骨质疏松症

退变性脊柱侧凸是50岁以后出现的脊柱侧凸，中、老年人多见，是指既往无脊柱侧凸史，骨骼成熟后伴随脊柱退行性改变而发生的原发性脊柱侧凸，近年来对于这种疾病的手术治疗方法有很多[1-2]，骨质疏松和退变性腰椎侧凸是一种老年人群中的常见病和多发病，两种疾病常常并发[3]。骨质疏松，给退变性腰椎侧凸的内固定治疗带来了很大的困难，常造成退变性腰椎侧凸内固定手术失败。本文笔者对26例退变性脊柱侧凸伴重度骨质疏松症病例，行长节段脊柱内固定时使用深螺纹螺钉、加大外展角、钉道内植骨，术后常规抗骨质疏松治疗1年，取得满意疗效，现报道如下：

1资料与方法

1.1一般资料

2007年4月～2011年4月在河北医科大学第三医院和廊坊市第四人民医院院收治的26例退变性脊柱侧凸伴骨质疏松患者，其中，女18例，男8例；年龄48～77岁，平均（68.3±3.2）岁。入选标准：患者行腰椎正侧位及腰椎MRI检查，明确退变性腰椎侧凸的诊断，同时行双能X线检查，并且达到诊断为骨质疏松症。排除标准：腰椎术后引起的侧凸，既往曾患有特发性脊柱侧凸，只有患有退变性腰椎侧凸，未达到诊断

长节段椎弓根螺钉矫形术固定治疗退变性腰椎侧凸

伴骨质疏松症

赵梦东1张子会2丁文元3曹来震1康永民1

1.河北省廊坊市第四人民医院医务科，河北廊坊065700；

2.河北省文安县妇幼保健医院，河北文安065800；

3.河北医科大学第三医院脊柱外科，河北石家庄050051

[摘要]目的探讨改良长节段椎弓根螺钉矫形术治疗退变性腰椎侧凸伴骨质疏松症的临床疗效。方法对26例退变性腰椎侧凸伴骨质疏松患者行长节段椎弓根螺钉矫形术，术中通过使用深螺纹螺钉、增大螺钉的外展角度、钉道内植骨等方法，术前进行Oswestry下腰痛功能障碍问卷调查表（ODI评分）及腰腿痛评分，术后平均随访20.8个月（8个月~3年），末次随访时进行ODI评分及腰腿痛评分，比较术前和术后ODI评分及腰腿痛评分。结果26例患者全部获得随访，术后ODI评分较术前明显减少（P＜0.05）；术后腰腿痛评分较术前显著增加，下肢功能明显改善（P＜0.05）。本组22例获得优良手术效果，优良率为84.6%。结论改良长节段椎弓根螺钉矫形术治疗退变性腰椎侧凸伴骨质疏松症是一种切实可行的手术方式，手术疗效明确。术中使用深螺纹螺钉、增大螺钉的外展角度、钉道内植骨是手术成功的关键。

[关键词]退变性腰椎侧凸；骨质疏松；长节段椎弓根螺钉

[中图分类号]R682.3[文献标识码]C[文章编号]1673-7210（2012）10（c）-0069-04

Clinical analysis of long segment pedicle screw fixation orthopmorphia in the treatment of degenerative lumbar scoliosis patients with osteoporosis

ZHAO Mengdong1ZHANG Zihui2DING Wenyuan3CAO Laizhen1KANG Yongming1

1.Department of Medical Services,the Fourth People′s Hospital of Langfang City,Hei Province,Langfang065700,Chi-

na；2.Maternity and Child Healthcare Hospital of Wen′an Country,Hebei Province,Wen′an065800,China；3.Department of Spinal Surgery,the Third Hospital of Hebei Medical University,Hebei Province,Shijiazhuang050051,China

[Abstract]Objective To evaluat the effectiveness of long segment pedicle screw fixation orthopmorphia in the treatment of degenerative lumbar scoliosis patients with osteoporosis.Methods26patients with degenerative lumbar scoliosis and os-teoporosis underwent improved long segment pedicle screw fixation orthopmorphia,during surgical operation use of screw with deep thread,enlarging abduction angle of screw and grafing bone in the opening of screw and so on,lumbago oswestry disability index(ODI)and the pain in waist and lower extremities grades were tested before operation,all patients had an average follower-up period of20.8months(8months to3years),then lumbag ODI scores and the pain in waist and lower extremities grade were tested at last follow-up,lumbag ODI and the pain in waist and lower extremities grades were com-pared.Results All26patients had a followed-up.Postoperative ODI had significant lower than that of preoperative,there was a significant difference(P＜0.05),the pain in waist and lower extremities grades had significantly improved;the func-tion of lower extremities grades had distinct improvement,there was a significant difference(P＜0.05).22patients had sat-isfactory operation results,with excellent and good ratio of84.6%.Conclusion Improved long segment pedicle screw fixa-tion orthopmorphia is feasible to the patients with lumbar scoliosis and osteoporosis,with significant therapeutic -ing of screw with deep thread,enlarging abduction angle of screw and grafing bone in the opening of screw is the key to ensure success of the surgery.

[Key words]Degenerative lumbar scoliotisis;Osteoporosis;Long segment pedicle screw

[作者简介]赵梦东（1962-），男，本科，主治医师；研究方向：创伤外科。

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