切换至 "中华医学电子期刊资源库"
高级检索
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
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

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/OL]. 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/OL]. 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
1
Santoni B G, Hynes R A, McGilvray K C, et al. Cortical bone trajectory for lumbar pedicle screws [J]. Spine J, 2009, 9(5): 366-373.
2
Perez-Orribo L, Kalb S, Reyes P M, et al. Biomechanics of lumbar cortical screw-rod fixation versus pedicle screw-rod fixation with and without interbody support [J]. Spine (Phila Pa 1976), 2013, 38(8): 635-641.
3
Akpolat Y T, Inceoglu S, Kinne N, et al. Fatigue Performance of Cortical Bone Trajectory Screw Compared With Standard Trajectory Pedicle Screw [J]. Spine (Phila Pa 1976), 2016, 41(6): E335-E341.
4
Matsukawa K, Yato Y, Kato T, et al. In vivo analysis of insertional torque during pedicle screwing using cortical bone trajectory technique [J]. Spine (Phila Pa 1976), 2014, 39(4): E240-E245.
5
Ding H, Hai Y, Liu Y, et al. Cortical Trajectory Fixation Versus Traditional Pedicle-Screw Fixation in the Treatment of Lumbar Degenerative Patients with Osteoporosis: A Prospective Randomized Controlled Trial [J]. Clin Interv Aging, 2022, 17: 175-184.
6
王洋,席焱海,吴学铭,等.应用皮质骨轨迹螺钉内固定治疗骨质疏松腰椎退变性疾病的临床疗效[J].中国矫形外科杂志, 2016, 24(21): 1938-1942.
7
Liu L, Zhang S, Liu G, et al. Early Clinical Outcome of Lumbar Spinal Fixation With Cortical Bone Trajectory Pedicle Screws in Patients With Osteoporosis With Degenerative Disease [J]. Orthopedics, 2019, 42(5): e465-e471.
8
Hoffman H, Verhave B, Jalal M S, et al. Comparison of Cortical Bone Trajectory Screw Placement Using the Midline Lumbar Fusion Technique to Traditional Pedicle Screws: A Case-Control Study [J]. Int J Spine Surg, 2019, 13(1): 33-38.
9
Galbusera F, Volkheimer D, Reitmaier S, et al. Pedicle screw loosening: a clinically relevant complication? [J]. Eur Spine J, 2015, 24(5): 1005-1016.
10
Marie-Hardy L, Pascal-Moussellard H, Barnaba A, et al. Screw Loosening in Posterior Spine Fusion: Prevalence and Risk Factors [J]. Global Spine J, 2020, 10(5): 598-602.
11
Li H M, Zhang R J, Gao H, et al. Biomechanical Fixation Properties of the Cortical Bone Trajectory in the Osteoporotic Lumbar Spine [J]. World Neurosurg, 2018, 119: e717-e727.
12
Chen C H, Chen D C, Huang H M, et al. Level-based analysis of screw loosening with cortical bone trajectory screws in patients with lumbar degenerative disease [J]. Medicine (Baltimore), 2020, 99(40): e22186.
13
Chen C H, Tu C H, Chen D C, et al. Incidence of Screw Loosening in Cortical Bone Trajectory Fixation Technique between Single- and Dual-Threaded Screws [J]. Medicines (Basel), 2021, 8(9).
14
Grigoryan G, Inceoglu S, Danisa O A, et al. Sacral Endplate Penetrating Screw for Lumbosacral Fixation: A Cadaveric Biomechanical Study [J]. Oper Neurosurg (Hagerstown), 2019, 17(4): 396-402.
15
Matsukawa K, Yato Y, Kato T, et al. Cortical bone trajectory for lumbosacral fixation: penetrating S-1 endplate screw technique: technical note [J]. J Neurosurg Spine, 2014, 21(2): 203-209.
16
Nakashima H, Kanemura T, Satake K, et al. The Prevalence and Risk Factors for S2 Alar-Iliac Screw Loosening with a Minimum 2-Year Follow-up [J]. Asian Spine J, 2020, 14(2): 177-184.
17
Banno T, Hasegawa T, Yamato Y, et al. Prevalence and Risk Factors of Iliac Screw Loosening After Adult Spinal Deformity Surgery [J]. Spine (Phila Pa 1976), 2017, 42(17): E1024-E1030.
18
武洵,申才良. CBT螺钉固定椎体单元的生物力学研究[J].安徽医科大学学报, 2019, 54(03): 482-487.
19
海涌,刘玉增,丁红涛.腰椎皮质骨轨迹螺钉的临床应用与展望[J].中华医学杂志, 2021, 101(45): 3691-3694.
20
Matsukawa K, Yato Y, Nemoto O, et al. Morphometric measurement of cortical bone trajectory for lumbar pedicle screw insertion using computed tomography [J]. J Spinal Disord Tech, 2013, 26(6): E248-E253.
21
Matsukawa K, Yato Y, Nemoto O, et al. Morphometric measurement of cortical bone trajectory for lumbar pedicle screw insertion using computed tomography [J]. J Spinal Disord Tech, 2013, 26(6): E248-E253.
22
Kaye I D, Prasad S K, Vaccaro A R, et al. The Cortical Bone Trajectory for Pedicle Screw Insertion [J]. JBJS Rev, 2017, 5(8): e13.
23
Matsukawa K, Yato Y. Lumbar pedicle screw fixation with cortical bone trajectory: A review from anatomical and biomechanical standpoints [J]. Spine Surg Relat Res, 2017,1(4): 164-173.
24
Bartenschlager S, Dankerl P, Chaudry O, et al. BMD accuracy errors specific to phantomless calibration of CT scans of the lumbar spine [J]. Bone, 2022, 157: 116304.
25
Zou D, Li W, Deng C, et al. The use of CT Hounsfield unit values to identify the undiagnosed spinal osteoporosis in patients with lumbar degenerative diseases [J]. Eur Spine J, 2019, 28(8): 1758-1766.
[1] 明昊, 肖迎聪, 巨艳, 宋宏萍. 乳腺癌风险预测模型的研究现状[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(05): 287-291.
[2] 庄燕, 戴林峰, 张海东, 陈秋华, 聂清芳. 脓毒症患者早期生存影响因素及Cox 风险预测模型构建[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(05): 372-378.
[3] 黄鸿初, 黄美容, 温丽红. 血液系统恶性肿瘤患者化疗后粒细胞缺乏感染的危险因素和风险预测模型[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(05): 285-292.
[4] 罗文斌, 韩玮. 胰腺癌患者首次化疗后中重度骨髓抑制的相关危险因素分析及预测模型构建[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 357-362.
[5] 贺斌, 马晋峰. 胃癌脾门淋巴结转移危险因素[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 694-699.
[6] 林凯, 潘勇, 赵高平, 杨春. 造口还纳术后切口疝的危险因素分析与预防策略[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 634-638.
[7] 杨闯, 马雪. 腹壁疝术后感染的危险因素分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 693-696.
[8] 周艳, 李盈, 周小兵, 程发辉, 何恒正. 不同类型补片联合Nissen 胃底折叠术修补食管裂孔疝的疗效及复发潜在危险因素[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 528-533.
[9] 张伟伟, 陈启, 翁和语, 黄亮. 随机森林模型预测T1 期结直肠癌淋巴结转移的初步研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 389-393.
[10] 吴天宇, 刘子璇, 杨浦鑫, 贾思明, 丁凯, 程晓东, 李泳龙, 陈伟, 吕红芝, 张奇. 腰椎间盘突出症保守治疗进展[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 379-384.
[11] 司楠, 孙洪涛. 创伤性脑损伤后肾功能障碍危险因素的研究进展[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 300-305.
[12] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
[13] 李文哲, 王毅, 崔建, 郑启航, 王靖彦, 于湘友. 新疆维吾尔自治区重症患者急性肾功能异常的危险因素分析[J/OL]. 中华卫生应急电子杂志, 2024, 10(05): 269-276.
[14] 刘志超, 胡风云, 温春丽. 山西省脑卒中危险因素与地域的相关性分析[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 424-433.
[15] 曹亚丽, 高雨萌, 张英谦, 李博, 杜军保, 金红芳. 儿童坐位不耐受的临床进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 510-515.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号