腰椎术中实测椎弓根螺钉扭矩及相关影响因素分析  

Intraoperative measurements of insertional torque of lumbar pedicle screw and analysis of contributing factors of pedicle screw strength

作　　者：庄乾宇[1] 李书纲[1] 盛林[1] 许德荣[1] 任志楠[1] 陈鑫[1] 蒋超[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》2016年第2期109-113,172,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:椎弓根螺钉锚定强度不足与术后松动等并发症相关,明确椎弓根螺钉强度影响因素对于术前计划、患者告知及术中决策具有重要意义。目的:探讨腰椎术中实测椎弓根螺钉扭矩的相关影响因素。方法:共纳入2013年1月至2015年8月我科收治的腰椎疾病患者134例。术中分别测量双侧L4螺钉拧入时的最大扭矩,记录平均值。以扭矩1.25 Nm作为界值将研究病例分为两组,比较两组患者年龄、性别、身高、体重、BMI、血钙、血磷、甲状旁腺素、25羟维生素D_3、1,25羟维生素D_3、β-胶原降解产物、髋关节及腰椎各部位骨密度。将有显著性差异的影响因素纳入多因素Logistic回归进一步分析。结果:术中实测L4双侧扭矩平均值为(1.28±0.43)Nm。单因素分析结果显示:相对于低扭矩组,高扭矩组有更高的甲状腺素、25羟维生素D_3、1,25羟维生素D_3水平,股骨颈、大转子、L1椎体、L2椎体、L3椎体、L4椎体、L1-L4平均骨密度以及L2-L4平均骨密度。多因素Logistic回归分析结果显示:L4椎体骨密度、1,25羟维生素D_3、甲状旁腺激素是独立影响因素。结论:椎弓根螺钉置入椎体骨密度、1,25羟维生素D_3、甲状旁腺激素是腰椎术中实测椎弓根螺钉扭矩的独立影响因素,对于评估腰椎椎弓根螺钉强度有重要预测价值。Background：Insufficient pedicle screw strength was reported to be highly correlated with postoperative screw loosening. Therefore, identification of related factors of pedicle screw strength is crucial for preoperative plan, patient con-sultation and intraoperative decision-making. Objective：To identify contributing factors of intraoperative insertional torque of lumbar pedicle screw. Methods：A total of 134 consecutive patients who underwent lumbar surgeries at our center from January 2013 to August 2015 were enrolled according to the inclusion/exclusion criteria. Maximum insertion torques （MIT） of L4 bilateral screws were measured during surgery, and the average were recorded. The cohort was classified into a low in-sertional torque group （IT〈1.25 Nm） and high insertional torque group （IT〉1.25 Nm）. Age, gender, height, weight, BMI, blood calcium, phosphate, parathyroid hormone, 25-dihydroxyvitamin D3, 1,25-dihydroxyvitamin D3,β-collagen degrada-tion products, BMD of hip joint and lumbar spine were compared between two groups. Candidate factors with significant difference between the two groups were further analyzed using binomial multiple logistic regression analysis. Results：Aver-age intraoperative insertional torque of L4 bilateral screws was （1.28 ± 0.43） Nm. Univariate analysis revealed higher para-thyroid hormone, 1,25-dihydroxyvitamin D3, BMD of femoral neck, greater tubercle, L1, L2, L3, L4, L1-L4 and L2-L4 ver-tebra in the high insertional torque group than the low insertional torque group. Binomial multivariate regression analysis demonstrated that BMD of L4 vertebra, 1,25-dihydroxyvitamin D3, and parathyroid hormone were independent contribut-ing factors. Conclusions：The BMD of the instrumented lumbar vertebra, 1,25-dihydroxyvitamin D3, parathyroid hormone are revealed as independent contributing factors of intraoperative insertional torque of lumbar pedicle screw, which may be of crucial predictive value of pedicle screws strength.

关 键 词：椎弓根螺钉 螺钉扭矩 骨密度 1 25羟维生素D3 甲状旁腺激素 

分 类 号：R687.3[医药卫生—骨科学]