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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2024, Vol. 10 ›› Issue (03) : 153 -158. doi: 10.3877/cma.j.issn.2096-0263.2024.03.005

骨质疏松

伴骨质疏松的单节段腰椎退行性变后路皮质骨轨迹螺钉固定治疗术后螺钉松动的危险因素分析
张苡齐1, 海涌1, 关立1, 潘爱星1, 张扬璞1, 丁红涛1, 李越1, 刘玉增1,†()   
  1. 1. 100020　首都医科大学附属北京朝阳医院骨科
  • 收稿日期:2023-03-20 出版日期:2024-06-05
  • 通信作者: 刘玉增
  • 基金资助:
    首都医科大学附属北京朝阳医院临床研究孵化项目(CYFH202316)

Risk factors of screw loosening after surgical treatment for single-level lumbar degenerative disease with osteoporosis utilizing cortical bone trajectory screw fixation

Yiqi Zhang1, Yong Hai1, Li Guan1, Aixing Pan1, Yangpu Zhang1, Hongtao Ding1, Yue Li1, Yuzeng Liu1,†()   

  1. 1. Department of Orthopedic Surgery, Beijing Chao-yang Hospital, Capital Medical, University, Beijing 100020, China
  • Received:2023-03-20 Published:2024-06-05
  • Corresponding author: Yuzeng Liu
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张苡齐, 海涌, 关立, 潘爱星, 张扬璞, 丁红涛, 李越, 刘玉增. 伴骨质疏松的单节段腰椎退行性变后路皮质骨轨迹螺钉固定治疗术后螺钉松动的危险因素分析[J]. 中华老年骨科与康复电子杂志, 2024, 10(03): 153-158.

Yiqi Zhang, Yong Hai, Li Guan, Aixing Pan, Yangpu Zhang, Hongtao Ding, Yue Li, Yuzeng Liu. Risk factors of screw loosening after surgical treatment for single-level lumbar degenerative disease with osteoporosis utilizing cortical bone trajectory screw fixation[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(03): 153-158.

目的

探讨后路皮质骨轨迹（CBT）螺钉固定治疗伴骨质疏松的单节段腰椎退行性变术后螺钉松动的危险因素。

方法

回顾性分析从2017年11月至2020年1月于首都医科大学附属北京朝阳医院骨科收治的88例应用CBT螺钉固定治疗的合并骨质疏松的单节段腰椎退行性变患者的临床资料，符合纳排标准的患者共70例，其中男性23例，女性47例，平均年龄为（62.87±10.07）岁，平均随访时间（25.53±1.82）个月，共计置入280枚螺钉。根据术后末次随访的影像学检查结果，将螺钉分为松动组（36枚）和未松动组（244枚），采用单因素分析螺钉是否固定至S1、螺钉所在区域的平均CT Hu值、螺钉矢状位角度、螺钉外展角度及螺钉接触皮质骨层数与CBT螺钉术后松动的相关性；采用多因素Logistic回归分析确定术后CBT螺钉松动的危险因素。

结果

单因素分析结果提示螺钉是否固定至S1（P<0.001）、螺钉外展角度（P<0.001）及螺钉接触皮质骨层数（P<0.001）与CBT螺钉固定治疗合并骨质疏松的单节段腰椎退行性变术后螺钉松动具有一定相关性；螺钉所在区域的平均CT Hu值与螺钉矢状位角度不具有相关性。多因素Logistic分析结果表明，螺钉是否固定至S1（OR=3.640，95%CI：1.08，12.25，P=0.037）、螺钉外展角度（OR=1.071，95%CI：1.00，1.14，P=0.037）及螺钉接触皮质骨层数（OR=0.189，95%CI：0.11，0.33，P<0.001）与术后CBT螺钉松动相关。

结论

CBT螺钉固定至S1、螺钉外展角度小及螺钉接触皮质骨层数少是后路CBT螺钉固定治疗合并骨质疏松的单节段腰椎退行性变术后螺钉松动的危险因素。

关键词: 腰椎融合术, 皮质骨轨迹螺钉, 危险因素, 腰椎
Objective

To investigate the risk factors of screw loosening after surgical treatment for single-level lumbar degenerative disease with osteoporosis utilizing cortical bone trajectory (CBT) screw fixation.

Methods

A retrospective study was conducted with 88 cases who diagnosed as lumbar degenerative disease with osteoporosis and underwent single-level posterior lumbar interbody fusion utilizing CBT screw fixation from November 2017 to January 2020 in Beijing Chao-Yang Hospital.Clinical data were recorded and a total of 70 patients (280 screws) were enrolled. The mean age was (62.87±10.07) years and the mean follow-up time was (25.53±1.82) months. According to the imaging findings, screws were divided into screw loosening group (36 screws) and Non-screw loosening group (244 screws). The correlation of screw fixed to S1, mean CT Hu value of the screw location, screw sagittal angle, screw lateral angle and the number of cortical bone layers was analyzed by univariate factor analysis. Multivariate Logistic regression analysis was used to determine the risk factors of postoperative screw loosening.

Results

Univariate analysis showed that screw fixed to S1 (P<0.001), screw lateral angle (P<0.001) and the number cortical bone layers (P<0.001) were correlated with screw loosening after CBT screw fixation for single-level lumbar degeneration complicated with osteoporosis. The mean CT Hu value of the screw location and sagittal angle of the screw were not correlated with screw loosening. Multivariate Logistic analysis showed that screw fixed to S1 (OR=3.640, 95%CI:1.08, 12.25, P=0.037), screw lateralangle (OR=1.071, 95%CI: 1.00, 1.14, P=0.037) and cortical bone layers (OR=0.189, 95%CI: 0.11, 0.33, P<0.001) were associated with postoperative CBT screw loosening.

Conclusion

The placement of CBT screw to S1, lateralangle of the screw and the number of cortical bone layers contacted by the screw are risk factors for screw loosening after surgical treatment for single-level lumbar degeneration disease with osteoporosis utilizing CBT screw fixation.

Key words: lumbar interbody fusion, cortical bone trajectory, risk factors, lumbar
图1~3 CBT螺钉测量参数。图1　腰椎CT轴位测量三处螺钉经过区域的Hu值；图2　螺钉外展角测量；图3　螺钉矢状位角度测量
表1 70例腰椎退行性变患者的基本特点资料
基本特点 数据
一般资料  
性别（男/女） 23/47
年龄（岁） 62.87±10.07
骨密度T值（SD） -3.04±0.49
BMI（kg/m2） 26.83±4.49
随访时间（月） 25.53±1.82
手术资料  
平均手术时间（分） 179.81±41.28
出血量（毫升） 211.43±75.03
手术节段位置[例（%）]  
L2/3 2（2.9）
L3/4 3（4.3）
L4/5 54（77.1）
L5/S1 11（15.7）
表2 70例腰椎退行性变患者临床疗效评分（分，±s）
时间 腰痛VAS评分 腿痛VAS评分 ODI评分
术前 4.43±1.98 2.50±1.13 49.26±6.71
术后6月 1.77±1.18 1.10±1.01 22.31±4.74
末次随访 1.66±1.11 0.87±0.74 20.93±4.63
t值 12.17 9.99 32.84
P值 0.001 0.001 0.001
表3 螺钉松动组与未松动组针对术后螺钉松动的单因素分析
变量 螺钉总数（280枚） 松动组（36枚） 未松动租（244枚） t/χ2/Z值 P值
是否固定至S1（M,QR，%） 20（7.1） 9（25） 11（4.5） 19.861 <0.001
CT Hu值 165.18±84.08 179.04±83.63 167.41±87.76 0.278 0.458
矢状位角（°） 75.97±7.10 75.72±8.05 75.93±7.15 -0.160 0.873
外展角（°） 10.77±5.72 13.94±6.53 10.36±5.49 3.620 <0.001
接触皮质层数（层） 4（3～4） 2（2～3） 4（3～4） -6.667 <0.001
表4 术后螺钉松动的多因素Logistic回归分析
变量 β SE Wald OR 95% CI P值
是否固定至S1 1.292 0.619 4.350 3.640 1.08，12.25 0.037
外展角 0.068 0.033 4.358 1.071 1.00，1.14 0.037
接触皮质层数 -1.665 0.280 35.433 0.189 0.11，0.33 <0.001
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