重度骨质疏松腰椎中不同剂量骨水泥强化椎弓根螺钉的稳定性分析  

Stability analysis of pedicle screw reinforced with different doses of bone cement in lumbar spine with severe osteoporosis

作　　者：韩桩汛 陈晓峰[1] 蔡东岭[1] 郭伟俊[1] 梁志洪 劳泽辉[1] HAN Zhuang-xun;CHEN Xiao-feng;CAI Dong-ling(Department of Orthopedics and Traumatology,Guangzhou Panyu Hospital of Traditional Chinese Medicine,Guangzhou Guangdong 511400,China)

机构地区：[1]广州市番禺区中医院骨伤科,广东广州511400

出　　处：《临床和实验医学杂志》2021年第11期1209-1212,共4页Journal of Clinical and Experimental Medicine

基　　金：广东市番禺区科技计划重点学科(专科)医疗卫生项目(编号:2019-Z04-08);广东省中医药局面上项目(编号:20191262)。

摘　　要：目的探究重度骨质疏松腰椎中不同剂量骨水泥强化椎弓根螺钉的稳定性。方法前瞻性研究,提取2020年1月至2020年9月保存广州市番禺区中医院保存的5具新鲜尸体上21个新鲜腰椎标本,并将42侧椎弓根按照随机原则分为6个组别(A~F组),先置入侧孔空心骨水泥螺钉,依次注入0、1.0、1.5、2.0、2.5、3.0 mL聚甲基丙烯酸甲酯(PMMA)。比较不同组别骨密度(BMD)测量结果;X线下观察各组螺钉包绕结果及有无PMMA渗漏发生;通过轴向拔出实验测定最大轴向拔出力(Fmax),比较不同组别Fmax结果;分析Fmax与PMMA剂量的相关性。结果各组BMD值均<0.6 g/cm 2,A~F组BMD值分别为(0.52±0.04)、(0.54±0.06)、(0.55±0.08)、(0.52±0.06)、(0.53±0.08)和(0.57±0.03)g/cm 2,不同组别比较,差异无统计学意义(P>0.05)。各组及各个标本均无PMMA渗漏的发生。A~F组Fmax分别为(363.39±56.21)、(483.12±53.29)、(547.29±75.20)、(720.37±120.22)、(852.49±202.49)、(1124.60±212.63)N,与A组比较,B~F组Fmax均有较大幅度提升,差异有统计学意义(P<0.05),但相邻两组间Fmax比较差异无统计学意义(P>0.05);经过Pearson相关性分析,显示Fmax与PMMA剂量呈明显正相关(r=0.894,P<0.05)。结论重度骨质疏松腰椎中注入PMMA能够提升侧孔空心骨水泥螺钉稳定性,当剂量为3 mL时能够达到理想的效果。Objective To investigate the stability of pedicle screws strengthened with different doses of bone cement in the lumbar spine with severe and severe osteoporosis.Methods In the prospective study,21 fresh lumbar vertebrae specimens were extracted from 5 fresh cadavers preserved in the Guangzhou Panyu Hospital of Traditional Chinese Medicine from January 2020 to September 2020.Forty-two sides of pedicle were randomly divided into 6 groups(A~F group).The lateral hole hollow bone cement screw was inserted first,and then 0,1.0,1.5,2.0,2.5,3.0 mL were injected successively PMMA.The bone mineral density(BMD)results of different groups were measured and compared;the screw wrapping results of each group and the occurrence of PMMA leakage were observed under X-ray;the maximum axial pull-out force(Fmax)was determined by the axial pull-out experiment,and compared Fmax results for different groups;the correlation between Fmax and PMMA dose was analyzed.Results The BMD values of each group were all<0.6 g/cm 2,and the BMD values of groups A to F were(0.52±0.04),(0.54±0.06),(0.55±0.08),(0.52±0.06),(0.53±0.08)and(0.57±0.03)g/cm 2,there was no statistically significant difference among different groups(P>0.05).No PMMA leakage occurred in each group and each specimen.Fmax of group A to group F was(363.39±56.21),(483.12±53.29),(547.29±75.20),(720.37±120.22),(852.49±202.49),(1124.60±212.63)N,respectively,and the difference was statistically significant(P<0.05),but there was no significant difference in Fmax between the two adjacent groups(P<0.05);Pearson correlation analysis showed a significant positive correlation between Fmax and PMMA dose(r=0.894,P<0.05).Conclusion PMMA injection into lumbar vertebrae with severe osteoporosis can improve the stability of lateral hole hollow bone cement screw,and the ideal effect can be achieved when the dosage is 3 ml.

关 键 词：重度骨质疏松 腰椎 骨水泥 侧孔空心骨水泥螺钉 剂量 稳定性 

分 类 号：R687.3[医药卫生—骨科学]