骨质疏松人工骨模块中PMMA剂量及分布对螺钉稳定性的影响  

Effect on pedicle screw stability of polymethylmethacrylate volume and distribution in synthetic bone block for patients with osteoporosis

作　　者：刘俊 罗杨[2] 刘达[3] 郑伟[3] 盛珺[3] 伍红桦[3] 谢庆云[3] 周江军[4] 

机构地区：[1]成都市天府新区人民医院骨科,成都610213 [2]成都军区总医院麻醉科,成都610083 [3]成都军区总医院骨科,成都610083 [4]解放军184医院骨科,江西鹰潭335000

出　　处：《解放军医学杂志》2017年第9期775-780,共6页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金青年基金项目(81301606);四川省卫生和计划生育委员会科研课题(16PJ020);中国博士后科学基金面上项目(2016M603054);成都军区总医院研究型人才资助项目(42412E33)~~

摘　　要：目的比较骨质疏松人工骨模块中聚甲基丙烯酸甲酯(PMMA)骨水泥剂量对不同侧孔螺钉稳定性的影响,分析螺钉稳定性与PMMA注射剂量及分布的关系。方法将骨质疏松人工骨模块随机分为A、B、C、D四个螺钉组,每组又随机分为0、1、2、3四个剂量(0、1.0、1.5、2.0ml PMMA)组。采用相同方法制备钉道后,A–C组分别拧入A、B、C三种可注射螺钉并注射不同剂量PMMA,D组向钉道内注射不同剂量PMMA后再拧入普通椎弓根螺钉。X线检查观察螺钉及PMMA分布情况;采用轴向拔出实验测量最大轴向拔出力(F_(max))。结果 X线检查结果显示,A1–A3组中PMMA包裹螺钉的前1/3,B1–B3组和C1-C3组中PMMA包裹螺钉的中1/3,D1–D3组中PMMA相对均匀地包裹螺钉的全长。两因素方差分析显示,PMMA剂量和分布两个因素对F_(max)均有显著影响(P<0.05),但两个因素之间无明显的相互作用(P=0.877)。在相同螺钉组间,注射1.0ml和1.5ml PMMA组、注射1.5ml和2.0ml PMMA组的F_(max)比较差异均无统计学意义(P>0.05),但注射2.0ml PMMA组的F_(max)明显高于注射1.0ml PMMA组(P<0.05)。在相同剂量PMMA组间,A0–D0各组间、A2–D2各组间、A3–D3各组间F_(max)差异无统计学意义(P>0.05);A1组中F_(max)明显低于D1组(P=0.026),其余各组间差异均无统计学意义(P>0.05)。除A1组F_(max)明显低于D1组(P=0.026)外,其余相同剂量PMMA组间比较F_(max)差异均无统计学意义(P>0.05)。结论 PMMA可显著提高骨质疏松人工骨中椎弓根螺钉的稳定性,且螺钉的稳定性与PMMA的注射剂量及分布有关。Objective To compare the stability of injectable pedicle screw with different lateral holes augmented with different volume of polymethylmethacrylate （PMMA）. in synthetic bone block used for patients with osteoporosis, and analyze the relationship between screw stability and injected volume and distribution pattern of PMMA. Methods The synthetic bone blocks used for patients with osteoporosis were randomly divided into groups A, B, C and D according to the screw difference, and the blocks in each group were then randomly divided again into subgroups 0, 1, 2 and 3 according to the difference of PMMA volume. A pilot hole was prepared in advance using the same method in all samples. Pedicle screws of type A-C were directly inserted into vertebrae of groups A-C respectively, and then different volumes of PMMA （0, 1.0, 1.5 and 2.0ml） were injected through screwinto the blocks of subgroups 0, 1, 2 and 3 respectively. The pilot hole was filled with different volumes of PMMA （0, 1.0, 1.5 and 2.0ml） followed by insertion of screw in groups DO, D1, D2 and D3 respectively. X-ray examination was performed to evaluate the screw position and PMMA distribution, and axial pull-out test was performed to measure the maximum axial pullout strength （FmJ. Results X-ray examination revealed that PMMA wrapt the anterior 1/3 part of screw in groups A1-A3, wrapt the middle 1/3 part of screw in groups B1-B3 and groups C1-C3, and evenly wrapt the full length of screw in groups D1-D3. Two factor ANOVA showed that both volume and distribution of PMMA significantly influenced F （P〈0.05）, but no marked interaction existed between the two factors （P=0.877）. Among groups with the same screw, no significant difference of Fmax was found between the groups injected of 1.0ml and 1.Sml PMMA and those of 1.5ml and 2.0ml PMMA （P〉0.05）, but the Fmax was significantly higher in groups with injection of 2.0ml PMMA than that in groups with injection of 1.0mI PMMA （P〈0.05）. Among the groups injected with same volume of PM

关 键 词：骨质疏松 椎弓根螺钉 聚甲基异丁烯酸 最大轴向拔出力 人工骨模块 

分 类 号：R681.5[医药卫生—骨科学]