摘要
背景:骨质疏松患者在进行椎弓根螺钉内固定时,尤其是进行调整后,螺钉松动的风险明显增加,采用PMMA进行钉道强化往往不可避免。目的:探讨在骨质疏松椎体中二次置钉条件下骨水泥(PMMA)注射剂量与椎弓根螺钉稳定的关系,以及PMMA的最佳注射剂量。方法:从6具尸体中选取30个腰椎标本(L1-L5),排除先天性畸形、骨折及肿瘤,确定为骨质疏松椎体后,将60侧椎弓根随机分为10个实验组(A-J组),A-E为初次置钉组,F-J为二次置钉组。分别经钉道向椎体内注入1.0、1.5、2.0、2.5、3.0 ml PMMA。拧入螺钉,X线观察PMMA分布情况,再进行周期抗屈实验,测量并分析周期抗屈最大负荷(Fmax)与PMMA剂量间的关系及各组间的Fmax的差异。结果:相同注射剂量时,二次置钉组Fmax均小于初次置钉组,除1 ml组(P=0.023)和1.5 ml组(P=0.043)外,其余剂量组间均无统计学意义(P>0.05)。AE组中,C组与D组、D组与E组、C组与E组间Fmax无统计学意义,其余各组间均有显著差异;F-J组中,I组与J组间无统计学意义,其余各组间均有显著差异。初次置钉与二次置钉时Fmax与PMMA剂量均呈正相关(r=0.662,r=0.686,P<0.05)。结论:在二次置钉条件下,注射一定剂量PMMA均能使椎弓根螺钉在骨质疏松椎体中获得良好的抗屈稳定性。注射剂量与稳定性呈正相关,初次置钉和二次置钉时的最佳注射剂量分别为2.0 ml及2.5 ml。
Background:The risk of screw loosening is significantly increased after screw adjustment in internal fixation in osteoporosis patients,so polymethylmethacrylate(PMMA)is usually unavoidable for enhancing.Objective:To study the relationship between injected volume of PMMA and pedicle screw stability and the preferred volume of PMMA in secondary screw implanting.Methods:Thirty vertebrae were obtained from six fresh-frozen human cadaveric lumbar spines.The vertebrae with congenital malformations,fractures and tumors were excluded.Sixty pedicles were randomly divided into 10 groups(A-J)after all samples were confirmed as osteoporotic vertebras.A-E were primary implanting groups and F-J were secondary implanting groups.PMMA(1.0,1.5,2.0,2.5 and 3.0 ml)was injected into vertebrae through the tunnel of screws after primary and secondary implanting.X-ray and periodic bending resistance strength test were performed to measure the maximum periodic bending resistance strength(Fmax).The relationship between PMMA volume and Fmax,and the difference of Fmax between groups were analyzed.Results:Fmax of each secondary group was lower than that of the primary group after injection of the same volume PMMA,but there was no significant difference except 1 ml group(P=0.023)and 1.5 ml group(P=0.043).In group A-E,there were significant difference in Fmax between other groups,except group C and D,group D and E,group C and E.In group F-J,there was no significant between the group I and the group J,while there were significant differences between the other groups.There was positive correlation between volume of PMMA and the Fmax both in primary groups and secondary groups(r=0.662,r=0.686,P<0.05).Conclusions:PMMA can enhance the stability of pedicle screw in osteoporotic vertebrae after secondary implanting.The volume is positively correlated with the stability.The preferred injecting volume is 2.0 ml and 2.5 ml for primary and secondary implanting,respectively.
作者
李浩
蔡东岭
欧志聪
褚学远
韩桩汛
郭伟俊
徐秋研
祝诚华
陈晓峰
LI Hao;CAI Dongling;OU Zhicong;ZHU Xueyuan;HAN Zhuangxun;GUO Weijun;XU Qiuyan;ZHU Chenghua;CHEN Xiaofeng(The Third Department of Orthopaedics,Panyu Hospital of Traditional Chinese Medicine,Guangzhou 511400,China)
出处
《中华骨与关节外科杂志》
2020年第10期848-852,共5页
Chinese Journal of Bone and Joint Surgery
基金
广州市番禺区科技医疗卫生项目-重点学科项目(2019-Z04-08)
关键词
骨水泥
二次置钉
周期抗屈实验
生物力学
Polymethylmethacrylate
Secondary Implantation
Periodic Bending Resistance Strength Test
Biomechanics
