探究扭矩测量法获得骶骨螺钉双皮质固定的可行性  

Feasibility study of sacral screw dual cortical fixation using torque measurement method

作　　者：姜国正 许卢春 马昱堃 关键斌 杨永栋[1] 熊洋[1] 曲弋 俞兴[1] 赵赫[1] Jiang Guozheng;Xu Luchun;Ma Yukun;Guan Jianbin;Yang Yongdong;Xiong Yang;Qu Yi;Yu Xing;Zhao He(Department of Orthopedics,Dongzhimen Hospital,Beijing University of Traditional Chinese Medicine,Beijing,100700;Department of Orthopedics,Honghui-Hospital,Xi'an Jiaotong University,Xi'an Shaanxi,710054,China)

机构地区：[1]北京中医药大学附属东直门医院骨科,北京100700 [2]西安交通大学医学院附属红会医院骨科,陕西西安710054

出　　处：《生物骨科材料与临床研究》2024年第3期15-20,共6页Orthopaedic Biomechanics Materials and Clinical Study

基　　金：潍坊奥精仿生骨多中心临床研究项目:仿生矿化胶原人工骨在脊柱疾病及骨折治疗中的疗效观察(HX-DZM-2018010)。

摘　　要：目的探究徒手结合扭矩测量法获得高骶骨螺钉双皮质率的可行性及获得双皮质固定最佳深度的方案。方法纳入2020年10月至2021年10月行后路腰椎动态固定的48例患者,根据螺钉置入深度分为双皮质180°组、360°组和720°组,对比各组病例骶骨螺钉置入扭矩、双皮质率及螺钉松动情况。结果所有病例平均随访时间为(13.5±5.1)个月(12~21个月)。双皮质180°组、360°组和720°组的双皮质率分别为66.67%、94.12%和93.75%:双皮质180°组与360°组、720°组比较,差异均有统计学意义(P<0.05);双皮质360°组和720°组比较,差异无统计学意义(P>0.05)。双皮质180°组、360°组和720°组骶骨螺钉松动率分别为23.33%、5.88%和3.13%:双皮质180°组与360°组、720°组比较,差异均有统计学意义(P<0.05);双皮质360°组和720°组比较,差异无统计学意义(P>0.05)。结论徒手结合扭矩测量法可以在较少经济支出情况下,获得较高骶骨双皮质率,安全性高,操作较为便捷,可辅助临床医生进行骶骨置钉。Objective To explore the feasibility of achieving a high dual cortical fixation rate for sacral screws using manual techniques combined with torque measurement,and to determine the optimal depth for dual cortical fixation.Methods Between October 2020 and October 2021,48 patients who underwent posterior lumbar dynamic fixation were included.All the cases were randomly divided into the dual cortical 180°group,360°group,and 720°group based on screw insertion depth.A comparative analysis was conducted among the groups regarding sacral screw insertion torque,dual cortical fixation rate,and screw loosening occurrences.Results The average follow-up time for all cases was(13.5±5.1)months(range:12-21 months).The dual cortical fixation rates were 66.67%,94.12%and 93.75%in the dual cortical 180°,360°,and 720°groups,respectively.The differences in dual cortical fixation rates were statistically significant between the dual cortical 180°group and the 360°group as well as the 720°group(P<0.05);there were no statistically significant differences in dual cortical fixation rates between the 360°group and the 720°group(P>0.05).The rates of sacral screw loosening were 23.33%,5.88%,and 3.13%in the dual cortical 180°,360°,and 720°groups,respectively.The differences in screw loosening rates were statistically significant between the dual cortical 180°group and the 360°group as well as the 720°group(P<0.05);there were no statistically significant differences in screw loosening rates between the 360°group and the 720°group(P>0.05).Conclusion The manual technique combined with the torque measurement method is a safe,effective,and stable approach for achieving dual cortical fixation of the sacral bone.

关 键 词：腰椎退行性病变 骶骨螺钉 螺钉松动 双皮质固定 置钉扭矩 置钉手感 

分 类 号：R687.3[医药卫生—骨科学]