Yuan Qiang, Zhang Guilin, Wu Jingye, Xing Yonggang, Sun Yuqing, Tian Wei
Department of Spine Surgery, Beijing Jishuitan Hospital, Peking University Fourth Clinical Medical College, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
Eur Spine J. 2015 May;24(5):1043-50. doi: 10.1007/s00586-013-3131-8. Epub 2013 Dec 28.
To evaluate the safety and efficacy of three-dimensional (3D) navigation-guided polymethylmethacrylate (PMMA)-augmented thoracic and lumbar pedicle screw fixation for the osteoporotic patients.
27 consecutive osteoporosis patients with a variety of spinal disorders who underwent 3D navigation-guided PMMA-augmented pedicle screw fixation were evaluated clinically and radiologically in the perioperative and 1-year follow-up period. The improvement of Japanese Orthopaedic Association (JOA) scores was analyzed. PMMA leakage and other complications were inspected intraoperatively and postoperatively. Screw loosening and bone fusion were evaluated radiographically during follow-up.
8 patients had thoracic and lumbar fractures; 18 patients had degenerative spinal disorders; one patient had revision surgery. One patient died of postoperative pneumonia. Each of the other 26 patients was followed up regularly at 3, 6, 12 and 18 months postoperatively. The mean therapeutic improvement rate is 39.6% evaluated by JOA scores. 2 patients (7.4%) had leakage into the spinal canal in front of the posterior longitudinal ligament and two patients (7.4%) had leakage into the prevertebral soft tissue inspected by the postoperative CT scans. No pedicle cortex breach and cement leakage surrounding pedicle cortex were observed. None of patients complained of dyspnoea and showed evidence of pulmonary embolism. Bone fusions were found in 20 patients (bony fusion rate 76.9%) at the 12-month follow-up and no screw loosening occurs.
The results show favorable outcome using 3D navigation-guided PMMA-augmented thoracic and lumbar pedicle screw fixation for the osteoporosis patients both clinically and radiologically.
评估三维（3D）导航引导下聚甲基丙烯酸甲酯（PMMA）强化胸腰椎椎弓根螺钉固定术治疗骨质疏松患者的安全性和有效性。
对27例连续的患有各种脊柱疾病的骨质疏松患者进行了3D导航引导下PMMA强化椎弓根螺钉固定术，并在围手术期和1年随访期进行了临床和放射学评估。分析了日本骨科协会（JOA）评分的改善情况。术中及术后检查PMMA渗漏及其他并发症。随访期间通过影像学评估螺钉松动和骨融合情况。
8例患者有胸腰椎骨折；18例患者有退行性脊柱疾病；1例患者进行了翻修手术。1例患者死于术后肺炎。其他26例患者术后分别于3、6、12和18个月进行定期随访。通过JOA评分评估的平均治疗改善率为39.6%。术后CT扫描检查发现2例患者（7.4%）在后纵韧带前方椎管内有渗漏，2例患者（7.4%）在椎体前软组织中有渗漏。未观察到椎弓根皮质破裂及椎弓根皮质周围骨水泥渗漏。所有患者均未诉呼吸困难，也未显示肺栓塞迹象。在12个月随访时，20例患者（骨融合率76.9%）发现有骨融合，未发生螺钉松动。
结果表明，3D导航引导下PMMA强化胸腰椎椎弓根螺钉固定术在临床和影像学方面治疗骨质疏松患者均取得了良好效果。
