单螺纹和双螺纹椎弓根螺钉抗拔出力比较的临床研究  

Comparison of pullout strength between single-threaded and dual-threaded pedicle screws: a clinical study

作　　者：盛林[1] 李书纲[1] 庄乾宇[1] 蔡思逸[1] 许德荣[1] 任志楠[1] 陈鑫[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院骨科,北京100730

出　　处：《中国骨与关节外科》2015年第2期140-144,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:椎弓根螺钉技术是目前脊柱固定融合最常用的方法。为减少螺钉松动和拔出等并发症,研究人员在螺钉设计等方面进行了不断探索。目的目的:比较单螺纹和双螺纹椎弓根螺钉应用于腰椎内固定术时的螺钉抗拔出力。方法方法:78例行腰椎椎弓根螺钉固定术的患者随机分为两组,所有患者术前均测量髋部骨密度和腰椎骨密度。一组在术中植入单螺纹椎弓根螺钉,另一组则植入双螺纹椎弓根螺钉,测量拧入每枚螺钉时的最大扭矩(以下简称"螺钉扭矩"),比较两组患者的骨密度和螺钉扭矩。结果结果:单螺纹螺钉组患者40例,术前髋部骨密度T值-1.82±0.57,腰椎骨密度T值-2.17±0.77,术中共植入单螺纹椎弓根螺钉150枚,螺钉扭矩(1.03±0.39)Nm。双螺纹螺钉组患者38例,术前髋部骨密度T值-1.90±0.62,腰椎骨密度T值-2.34±0.81,共植入双螺纹椎弓根螺钉150枚,螺钉扭矩(1.45±0.39)Nm。两组患者术前骨密度无明显差异(P>0.05),双螺纹螺钉组的螺钉扭矩显著高于单螺纹螺钉组(P<0.001)。结论结论:相较于单螺纹椎弓根螺钉,双螺纹椎弓根螺钉应用于腰椎内固定术可增加螺钉的抗拔出力。Background：Nowadays, pedicle screws technology is the most commonly used method in spinal fixation and fusion. Much has been explored concerning pedicle screws designing process in order to reduce occurrence of complications such as screw loose and pullout. Objective：To compare the pullout strength between single-threaded and dual-threaded pedicle screws when applied in lum-bar spinal surgeries with internal fixation. Methods：A series of 78 patients undergoing lumbar surgeries with pedicle screws as internal fixation instruments were ran-domly assigned into two groups：Single-threaded pedicle screws and dual-threaded screws were implanted, respectively, in the two groups. Bone density measurement （BMD） of the hip region and lumbar vertebrae were acquired in all patients prior to surgeries. Additionally, maximum insertion torque （MIT） was measured when every screw was inserted during each sur-gery. Results of BMD （T value） and MIT （Nm） were compared between the two groups. Results：In the single-threaded group, there were 40 patients in whom a total number of 150 pedicle screws were implanted;T value of preoperative BMD of the hip region was-1.82±0.57 and that of the lumbar vertebrae was-2.17±0.77;mean MIT was 1.03±0.39. In the dual-threaded group, there were 38 patients with also a total number of 150 pedicle screws being in-strumented, and the parameters of preoperative BMD of the hip region and lumbar vertebrae as well as MIT were-1.90 ± 0.62,-2.34 ± 0.81 and 1.45 ± 0.39, respectively. No statistical significant difference was found between the two groups con-cerning preoperative BMD （P〉0.05）, however, MIT distinguished between each other with dual-threaded group demonstrat-ed a greater value than that of the single-threaded group （P〈0.001）. Conclusions：In comparison with single-threaded pedicle screws, dual-threaded pedicle screws, when applied in lumbar sur-geries with internal fixations, have been shown to have greater pullout strength.

关 键 词：椎弓根螺钉 扭矩 

分 类 号：R687.3[医药卫生—骨科学]