Department of Orthopedics and Traumatology, Spine Surgery, Ospedale Maggiore C.A. Pizzardi, Largo Nigrisoli 2, Bologna, Italy.
J Orthop Traumatol. 2011 Dec;12(4):193-9. doi: 10.1007/s10195-011-0164-9. Epub 2011 Nov 8.
This prospective mixed cohort study was designed to evaluate the middle- to long-term purchase of cement-augmented pedicular screws in patients with poor bone quality. The growing number of surgical procedures performed in the spine has highlighted the problem of screws loosening in patients with poor bone stock due to osteoporosis and/or tumors. Different methods of increasing screw purchase have been reported in the literature, including polymethylmethacrylate (PMMA) augmentation.
From September 2006 to April 2008, 21 patients with a poor bone stock condition due to osteoporosis or tumor underwent posterior stabilization by fenestrated pedicle screws and PMMA augmentation. Pain improvement and long-term clinical outcome were assessed by visual analogue scale (VAS) score and SF-36 health survey (SF-36) questionnaire. Implant stability was evaluated by plain radiography and CT scans performed three days after surgery and every three months thereafter. After the first 12 months, radiologic controls were taken once a year in all surviving patients. Complications were evaluated in all cases.
All patients were clinically and radiographically followed up for a mean of 36 months. VAS scores and SF-36 questionnaires showed a statistically significant reduction in pain and improvement in the quality of life. No radiological loosening or pulling out of screws was observed. In two cases, cement leakage occurred intraoperatively: one patient who suffered from a transitory nerve root palsy improved spontaneously, while the surgeon immediately removed the excess cement before setting in the other case. In three cases, the post-op CT scan revealed a small amount of cement in the canal without clinical relevance.
Fenestrated screws for cement augmentation provided effective and lasting purchase in patients with poor bone quality due to osteoporosis or tumors. No case of loosening was recorded after a mean follow-up of 36 months. The only clinical complication strictly related to PMMA screw augmentation did not require further surgery.
本前瞻性混合队列研究旨在评估骨质量差的患者中使用水泥增强椎弓根螺钉的中-长期购买情况。由于骨质疏松症和/或肿瘤，脊柱手术数量不断增加，导致骨量差的患者螺钉松动的问题凸显。文献中报道了增加螺钉购买的不同方法，包括聚甲基丙烯酸甲酯（PMMA）增强。
2006 年 9 月至 2008 年 4 月，21 例因骨质疏松症或肿瘤导致骨量差的患者接受开窗椎弓根螺钉和 PMMA 增强的后路稳定。通过视觉模拟评分（VAS）和 SF-36 健康调查（SF-36）问卷评估疼痛改善和长期临床结果。术后第 3 天及以后每 3 个月进行平片和 CT 扫描评估植入物稳定性。在所有存活患者中，在最初 12 个月后每年进行放射学对照检查。所有病例均评估并发症。
所有患者均进行了临床和放射学随访，平均随访 36 个月。VAS 评分和 SF-36 问卷显示疼痛明显减轻，生活质量得到改善。未观察到螺钉松动或拔出。术中发生 2 例水泥渗漏：1 例神经根麻痹患者症状自行改善，而另 1 例在设置螺钉前，术者立即清除了多余的水泥。在 3 例病例中，术后 CT 扫描显示椎管内有少量水泥，但无临床意义。
开窗螺钉加水泥增强为骨质疏松症或肿瘤导致骨质量差的患者提供了有效且持久的购买效果。平均随访 36 个月后，未记录到松动病例。唯一与 PMMA 螺钉增强相关的临床并发症无需进一步手术。
