Department of Orthopaedic Surgery, Affiliated Changhai Hospital of The Second Military Medical University, 168 Changhai Road, Shanghai, PR China.
BMC Musculoskelet Disord. 2011 Dec 21;12:286. doi: 10.1186/1471-2474-12-286.
The operative treatment of adult degenerative scoliosis combined with osteoporosis increase following the epidemiological development. Studies have confirmed that screws in osteoporotic spines have significant lower-screw strength with more frequent screw movements within the vertebra than normal spines. Screws augmented with polymethylmethacrylate (PMMA) or with autogenous bone can offer more powerful corrective force and significant advantages.
A retrospective analysis was conducted on 31 consecutive patients with degenerative lumbar scoliosis combined with osteoporosis who had surgery from December 2000. All had a minimum of 2-year follow-up. All patients had posterior approach surgery. 14 of them were fixed with pedicle screw by augmentation with polymethylmethacrylate (PMMA) and the other 17 patients with autogenous bone. Age, sex and whether smoking were similar between the two groups. Surgical time, blood loss, blood transfusion, medical cost, post surgery ICU time, hospital day, length of oral pain medicines taken, Pre-and postoperative Oswestry disability index questionnaire and surgical revision were documented and compared. Preoperative, postoperative and final follow up Cobb angle, sagittal lumbar curve, correction rate, and Follow up Cobb loss were also compared.
No significant differences were found between the autogenous bone group and polymethylmethacrylate group with regards to all the targets above except for length of oral pain medicines taken and surgery cost. 2 patients were seen leakage during operation, but there is neither damage of nerve nor symptom after operation. No revision was needed.
Both augmentation pedicle screw with polymethylmethacrylate (PMMA) and autogenous bone treating degenerative lumbar scoliosis combined with osteoporosis can achieve a good surgical result. Less oral pain medicines taken are the potential benefits of polymethylmethacrylate augmentation, but that is at the cost of more medical spending.
随着流行病学的发展，成人退行性脊柱侧凸合并骨质疏松症的手术治疗逐渐增多。研究证实，骨质疏松脊柱中的螺钉具有明显较低的螺钉强度，并且比正常脊柱中的螺钉更容易在椎体内移动。用聚甲基丙烯酸甲酯（PMMA）或自体骨增强的螺钉可以提供更强的矫正力和显著的优势。
对 2000 年 12 月以来连续 31 例退行性腰椎侧凸合并骨质疏松症患者进行回顾性分析，所有患者均随访至少 2 年。所有患者均行后路手术。其中 14 例采用 PMMA 增强的椎弓根螺钉固定，另 17 例采用自体骨固定。两组患者的年龄、性别和吸烟情况相似。记录并比较手术时间、出血量、输血、医疗费用、术后 ICU 时间、住院天数、口服止痛药使用时间、术前和术后 Oswestry 功能障碍指数问卷和手术翻修情况。比较术前、术后和最终随访 Cobb 角、矢状腰椎曲线、矫正率和随访 Cobb 丢失。
自体骨组和 PMMA 组在除口服止痛药使用时间和手术费用外的所有指标上均无显著差异。2 例术中见渗漏，但术后无神经损伤和症状。不需要修改。
PMMA 增强和自体骨增强椎弓根螺钉治疗退行性腰椎侧凸合并骨质疏松症均可获得良好的手术效果。PMMA 增强的潜在益处是减少口服止痛药的使用，但这是以增加医疗费用为代价的。
