中国组织工程研究 第17卷 第52期 2013–12–24出版Chinese Journal of Tissue Engineering Research December 24, 2013 Vol.17, No.52doi:10.3969/j.issn.2095-4344.2013.52.001 [] 江泽华，朱如森，袁建军，邵高升，张学利. 腰椎内固定中两种椎弓根钉加强技术与骨水泥的应用[J].中国组织工程研究，2013，17(52):8941-8948.ISSN 2095-4344 CN 21-1581/R CODEN: ZLKHAH8941 www.CRTER .org江泽华★，男，1983年生，南开大学医学院在读硕士，主要从事退行性脊柱病的治疗。
jiangzehua88@ 通讯作者：张学利，主任医师，硕士生导师，天津市人民医院脊柱一科，天津市 300121zxlspine@中图分类号:R318 文献标识码:A 文章编号:2095-4344 (2013)52-08941-08修回日期：2013-09-19 (201306009/W ·C)Jiang Ze-hua ★, Studying for master’s degree, School of Medicine, Nankai University, Tianjin 300121, China jiangzehua88@Corresponding author: Zhang Xue-li, Chief physician, First Department of Spine, Tianjin People’s Hospital, Tianjin 300121, China zxlspine@Accepted: 2013-09-19腰椎内固定中两种椎弓根钉加强技术与骨水泥的应用★江泽华1，朱如森2，袁建军2，邵高升3，张学利2(1南开大学医学院，天津市 300121；2天津市人民医院脊柱一科，天津市 300121；3天津中医药大学，天津市 300193)文章亮点：经大量硫酸钙骨水泥强化椎弓根螺钉实践操作，作者认为，在骨水泥的应用中低温保存，即开即用，可延长凝固时间；硫酸钙骨水泥在调制时避免过稀和过稠，调至成“胶冻”样即注入，防止过早固化或渗漏；使用C 型臂不断的透视，进针要深些，看到骨水泥包绕椎弓根钉进钉深度的50%时，降低注入速度，缓慢注入，直到骨水泥扩散到椎体后缘时停止注射，避免骨水泥渗漏。
关键词：骨关节植入物；脊柱植入物；腰椎；聚甲基丙烯酸甲酯；可注射硫酸钙；骨质疏松；腰椎内固定；椎弓根钉；骨密度 主题词：腰椎；聚甲基丙烯酸类；骨质疏松；内固定器 缩略语：Oswestry 功能障碍指数：Oswestry disability index ，ODI ；日本骨科协会评估治疗分数：Japanese Orthopaedic Association Scores ，JOA摘要背景：骨质疏松伴腰椎退行性病变行椎弓根钉固定骨质疏松的椎体后可能会出现螺钉的松动、脱落，使用固化材料强化椎弓根钉能提高治疗效果。
目的：比较骨质疏松患者腰椎内固定中使用聚甲基丙烯酸甲酯骨水泥和可注射硫酸钙骨水泥加强椎弓根钉两种技巧的临床效果。
方法：腰椎滑脱、腰椎失稳、严重腰椎管狭窄合并骨质疏松的患者共61例，根据治疗方式分为2组：传统聚甲基丙烯酸甲酯强化椎弓根钉组和可注射硫酸钙骨水泥强化椎弓根钉组。
结果与结论：两组患者治疗操作时间、出血量、治疗前后目测类比评分、日本骨科协会评估治疗分数评分及改善率比较差异均无显著性意义(P > 0.05)。
聚甲基丙烯酸甲酯组中2例患者出现了注入的骨水泥渗漏，随访未造成新的神经损伤。
聚甲基丙烯酸甲酯组患者治疗后骨密度随着随访时间的延长未出现逐渐的增强趋势；硫酸钙骨水泥组患者治疗后骨密度出现渐进性的改善，与患者治疗后日本骨科协会评估治疗分数改善率呈线性相关。
两组患者未出现螺钉松动、拔出及神经功能的异常。
表明与聚甲基丙烯酸甲酯相似，硫酸钙骨水泥能增加椎弓根螺钉的稳定性。
Two strengthening pedicle screw techniques and bone cement in lumbar internal fixationJiang Ze-hua 1, Zhu Ru-sen 2, Yuan Jian-jun 2, Shao Gao-sheng 3, Zhang Xue-li 2 (1School of Medicine,Nankai University, Tianjin 300121, China; 2First Department of Spine, Tianjin People’s Hospital, Tianjin 300121, China; 3Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China)AbstractBACKGROUND: Screw loosening and shedding may occur after osteoporosis associated with lumbardegenerative disease treated with pedicle screw fixation. Application of pedicle screw enhanced with cured materials can improve the therapeutic effect.OBJECTIVE: To compare the clinical effect of pedicle screws enhanced with poly(methyl methacrylate) and injectable calcium sulfate cement in the lumbar internal fixation of osteoporosis.METHODS: Sixty-one patients diagnosed with osteoporosis combined with lumbar spondylolisthesis, lumbar spinal instability, and severe lumbar spinal stenosis were collected. All patients were divided into two groups according to the treatment method: poly(methyl methacrylate) bone cement enhanced pedicle screw group and calcium sulfate bone cement enhanced pedicle screw group.RESULTS AND CONCLUSION: There were no significant differences in the operation time, blood loss, preoperative and postoperative visual analog scale score, Japanese Orthopedic Association scores and the Japanese Orthopedic Association score improvement rate between two groups (P > 0.05). The results showed that two patients had bone cement leakage in poly(methyl methacrylate) group which had no neurologicalP .O. Box 1200, Shenyang 110004 8942symptoms caused by new symptoms during follow-up period. The bone mineral density was not improved gradually in poly(methyl methacrylate) group with follow-up time prolonging; however, in calcium sulfate group, the bone mineral density was increased significantly after treatment, and the change of bone mineral density was linearly related with Japanese Orthopaedic Association score improvement rate in calcium sulfate group. No screw loosening, pulling out or neurological dysfunction occurred in both groups. The results indicate that like poly(methyl methacrylate), balcium sulfate bone cement can increase the stability of pedicle screws.Subject headings: lumbar vertebrae; polymethacrylic acids; osteoporosis; internal fixatorsJiang ZH, Zhu RS, Yuan JJ, Shao GS, Zhang XL. Two strengthening pedicle screw techniques and bone cement in lumbar internal fixation. Zhongguo Zuzhi Gongcheng Yanjiu. 2013;17(52):8941-8948.0 引言 Introduction对于腰椎退行性病变如腰椎滑脱、腰椎失稳、严重腰椎管狭窄患者的治疗，骨质疏松成为治疗的主要制约因素，椎弓根钉固定骨质疏松的椎体后可能会出现螺钉的松动、脱落，使用固化材料强化椎弓根钉能提高治疗效果[1]。
传统的骨水泥聚甲基丙烯酸甲酯能显著加强椎弓根钉的治疗中治疗后的力学稳定性，但是因为聚甲基丙烯酸甲酯的生物学特征如聚热效应，可能损伤神经和其他组织；以及由于其坚强的固定效果，可能会出现翻修困难等弊端。