不同剂量聚甲基丙烯酸甲酯强化锚钉在骨质疏松骨模块中的稳定性差异  

Stability difference of varied doses of polymethylmethacrylate reinforced anchor in osteoporotic bone module

作　　者：董伊隆 钱约男 张侠 李一民 蔡春元 刘良乐 DONG Yilong;QIAN Yuenan;ZHANG Xia;LI Yimin;CAI Chunyuan;LIU Liangle(Department of Orthopaedics,the Third Affiliated Hospital of Wenzhou Medical University,Wenzhou 325200,China;Department of Ultrasonography,the Third Affiliated Hospital of Wenzhou Medical University,Wenzhou 325200,China)

机构地区：[1]温州医科大学附属第三医院骨外科,浙江温州325200 [2]温州医科大学附属第三医院影像科,浙江温州325200

出　　处：《温州医科大学学报》2021年第11期912-916,共5页Journal of Wenzhou Medical University

基　　金：温州市医药卫生科研项目(2020036)。

摘　　要：目的:比较骨质疏松骨模块中不同剂量聚甲基丙烯酸甲酯(PMMA)强化锚钉的稳定性,分析锚钉稳定性与PMMA剂量间的相关关系,并寻找最佳PMMA骨水泥注射剂量。方法:将36个骨质疏松骨模块随机分为A至F 6个实验组,A组为空白组,直接拧入锚钉;B组至F组注射器推杆精确分别向钉道内直接注入0.5、1.0、1.5、2.0、2.5 mL PMMA骨水泥,待骨水泥硬化后进行X线检查,观察螺钉周围骨水泥的分布情况;随后进行力学实验,测量最大轴向拔出力(Fmax)并观察模块的破坏情况。结果:A组至F组的Fmax分别为(145.50±23.82)N、(188.67±34.90)N、(234.00±21.14)N、(296.80±18.55)N、(445.00±33.72)N和(458.60±25.54)N,各组间差异具有统计学意义(F=143.020,P<0.001)。PMMA剂量为0~2 mL,Fmax与PMMA剂量之间存在正相关关系(r=0.948,P<0.05)。锚钉拔出后各组模块均有不同程度的破坏。从A组到E组,模块的破坏程度逐渐加重,E组和F组中模块的破坏相差无几。结论:PMMA可以显著提高骨质疏松骨模块中锚钉的稳定性,在0~2.0 mL中,锚钉的稳定性随PMMA剂量的增加而提高。在临床上推荐PMMA的剂量为2.0 mL。Objective:To compare the anchor stability strengthened by polymethylmethacrylate(PMMA)with varied doses in osteoporotic bone modules and analyze the correlation between anchor stability and PMMA dose,and then,to find the optimal PMMA cement injection dose.Methods:Thirty-six osteoporotic bone modules were randomly divided into 6 experimental groups(A-F,n=6):group A(blank group),which was directly screwed into the anchor;group B-F,through injector push rod,were injected respectively with an accurate dose of 0.5,1.0,1.5,2.0,and 2.5 mL PMMA bone cement into the screw channel.Then,X-ray examination was performed after the cement was hardened,followed by the observation of the bone cement distribution around the screw.Mechanical experiments were performed to measure the maximum axial pullout force(Fmax)and the destruction of the module observed.Results:The Fmax of group A-F was(145.50±23.82)N,(188.67±34.90)N,(234.00±21.14)N,(296.80±18.55)N,(445.00±33.72)N and(458.60±25.54)N,respectively,with significant statistical difference between the groups(F=143.020,P<0.001).There was positive correlation between Fmax and PMMA dose 0-2 mL,Pearson correlation coefficient(r=0.948,P<0.05).The modules in all groups were damaged to varying degrees after anchor pullout.The damage degree of the module from group A to group E was gradually aggravated,while the module’s damage for E and F was nearly the same.Conclusion:PMMA can significantly improve the anchor stability in osteoporotic bone modules,and the stability of anchors increases with the increase of PMMA dose among 0-2 mL.The recommended dose of PMMA in clinical practice is 2.0 mL.

关 键 词：骨质疏松 锚钉 甲基丙烯酸甲酯类 生物力学 最大轴向拔出力 

分 类 号：R725.5[医药卫生—儿科]