骨水泥强化椎弓根螺钉联合椎间融合复位治疗老年重度腰椎滑脱的临床研究

摘要 目的：观察椎间融合复位联合骨水泥强化椎弓根螺钉治疗老年重度腰椎滑脱的临床效果。方法：回顾性分析我院于2016年3月~2019年3月期间收治的老年重度腰椎滑脱患者92例，根据治疗方案的不同可将患者分为A组（n=44）和B组（n=48），A组给予椎弓根螺钉联合椎间融合复位治疗，B组给予骨水泥强化椎弓根螺钉联合椎间融合复位治疗，对比两组视觉疼痛模拟评分（VAS）、Oswestry功能障碍指数（ODI）及日本骨科协会（JOA）腰腿痛评分、临床指标、滑脱距离、滑脱率、椎间隙高度、椎间融合率、椎间孔高度、并发症及螺钉松动情况。结果：术后12个月，两组VAS、ODI、JOA评分均下降，且B组低于A组（P<0.05）。两组术中出血量对比组间无统计学差异（P>0.05），B组手术时间长于A组，住院时间短于A组，椎间融合率高于A组（P<0.05）。术后12个月，两组滑脱距离、滑脱率均下降，且B组小于A组（P<0.05）。术后12个月，两组椎间隙高度、椎间孔高度均升高，且B组高于A组（P<0.05）。两组并发症发生率组间对比无差异（P>0.05）。结论：老年重度腰椎滑脱患者椎间融合复位联合骨水泥强化椎弓根螺钉治疗，虽一定程度上延长了手术时间，但可促进临床症状，改善椎间高度及腰椎滑脱程度，缩短住院时间，且不增加并发症发生率。

Clinical Study of Bone Cement Reinforced Pedicle Screw Combined with Interbody Fusion in the Treatment of Elderly Patients with Severe Lumbar Spondylolisthesis

ABSTRACT Objective: To observe the clinical effect of bone cement reinforced pedicle screw combined with interbody fusion in the treatment of elderly patients with severe lumbar spondylolisthesis. Methods: 92 elderly patients with severe lumbar spondylolisthesis who were treated in our hospital from March 2016 to March 2019 were retrospectively analyzed. According to different treatment schemes, the patients were divided into group A (n=44) and group B (n=48). Group A was given pedicle screw combined with intervertebral fusion reduction, and group B was given bone cement reinforced pedicle screw combined with intervertebral fusion reduction. Visual pain simulation score (VAS), Oswestry disability index (ODI) and Japanese Orthopaedic Association (JOA) low back and leg pain score, clinical indicators, slip distance, slip rate, intervertebral space height, intervertebral fusion rate, intervertebral foramina height, complications and screw loosening in the two groups. Results: 12 months after operation, VAS, ODI and JOA scores of the two groups decreased, and the group B was lower than the group A (P<0.05). There was no significant difference in intraoperative blood loss between the two groups (P>0.05). The operation time of group B was longer than that of group A, and the hospitalization time was shorter than that of group A, the intervertebral fusion rate was higher than group A (P<0.05). 12 months after operation, the slip distance and the slip rate in both groups decreased, and the group B was smaller than the group A (P<0.05). 12 months after operation, the intervertebral space height and intervertebral foramen in both groups increased, and the group B was higher than the group A (P<0.05). There was no difference in the incidence of complications between the two groups (P>0.05). Conclusion: Although the intervertebral fusion reduction combined with bone cement enhanced pedicle screw treatment for elderly patients with severe lumbar spondylolisthesis can prolong the operation time to some extent, it can promote clinical symptoms, improve the height of intervertebral space and the degree of lumbar spondylolisthesis, shorten the hospitalization time, and do not increase the incidence of complications.