CAJ | 학술논문

目的：比较不同剂量聚甲基丙烯酸甲酯（PMMA）骨水泥强化骨质疏松人工骨模块中椎弓根螺钉的稳定性，分析螺钉稳定性与PMMA剂量间的关系。方法48块骨质疏松人工骨模块随机分为6组。制备钉道后，A组直接拧入椎弓根螺钉，B～F组：依次向钉道内注入1 ml、2 ml、3 ml、4 ml、5 ml PMMA后拧入椎弓根螺钉。24 h后进行X线检查和轴向拔出实验并测量最大轴向拔出力（Fmax）,然后观察螺钉残骸及模块破坏的情况。结果 X线检查示：A组螺钉被周围PU材料所包绕；B～F组螺钉被PMMA严密包绕。生物力学实验表明：与A组相比，B～F组中Fmax的提高程度分别为417.2%、495.9%、636.9%、725.4%和791.5%，差异均具有统计学意义（P<0.05）。B组和C组之间，D组和E组之间，E组和F组之间Fmax的差异均不具有统计学意义（P=0.122, P=0.084，P=0.192），其余各组间的差异均具有统计学意义（P<0.05）。Fmax与PMMA剂量之间存在显著的正相关关系（r=0.882，P<0.05）。螺钉拔出后各组模块均有不同程度的破坏，从A组至F组模块的破坏逐渐增加。结论 PMMA可以显著提高骨质疏松条件下椎弓根螺钉的稳定性，螺钉稳定性随PMMA剂量的增加而提高。但在某个范围内增加PMMA的剂量并不能显著提高螺钉的稳定性，反而会增加PMMA的渗漏风险。本研究中注射3 ml PMMA可以作为合适的选择。
목적：비교불동제량취갑기병희산갑지（PMMA）골수니강화골질소송인공골모괴중추궁근라정적은정성，분석라정은정성여PMMA제량간적관계。방법48괴골질소송인공골모괴수궤분위6조。제비정도후，A조직접녕입추궁근라정，B～F조：의차향정도내주입1 ml、2 ml、3 ml、4 ml、5 ml PMMA후녕입추궁근라정。24 h후진행X선검사화축향발출실험병측량최대축향발출력（Fmax）,연후관찰라정잔해급모괴파배적정황。결과 X선검사시：A조라정피주위PU재료소포요；B～F조라정피PMMA엄밀포요。생물역학실험표명：여A조상비，B～F조중Fmax적제고정도분별위417.2%、495.9%、636.9%、725.4%화791.5%，차이균구유통계학의의（P<0.05）。B조화C조지간，D조화E조지간，E조화F조지간Fmax적차이균불구유통계학의의（P=0.122, P=0.084，P=0.192），기여각조간적차이균구유통계학의의（P<0.05）。Fmax여PMMA제량지간존재현저적정상관관계（r=0.882，P<0.05）。라정발출후각조모괴균유불동정도적파배，종A조지F조모괴적파배축점증가。결론 PMMA가이현저제고골질소송조건하추궁근라정적은정성，라정은정성수PMMA제량적증가이제고。단재모개범위내증가PMMA적제량병불능현저제고라정적은정성，반이회증가PMMA적삼루풍험。본연구중주사3 ml PMMA가이작위합괄적선택。
Objective To compare stability of pedicle screw augmented with different volume of polymethylmethacrylate (PMMA) in osteoporotic synthetic bone block and analyze the relationship between screw stability and volume of PMMA. Methods Forty-eight osteoporotic synthetic bone blocks were randomly divided into six groups. A pilot hole was prepared in advance using the same method in all samples. Then, pedicle screw was directly inserted in group A, the pilot hole was filled with different volume of PMMA (1 ml, 2 ml, 3 ml, 4 ml and 5 ml) followed by insertion of screw in groups B, C, D, E and F, respectively. Twenty four hours later, X-ray examination and axial pull-out tests were performed in all groups, and the maximum axial pullout strength was measured. Then, the remains of screw and destruction of blocks were observed. Results X-ray examination revealed that, the screw was surrounded directly by polyurethane material in group A. From groups B to F, screws were wrapped up by PMMA and PMMA was found existing in the polyurethane material around screws. Biomechanical tests revealed that, Fmax in groups B-F were significantly increased 417.2%, 495.9%, 636.9%, 725.4% and 791.5% compared with that in group A(P<0.05). There were no significantly differences on Fmax between groups B and C, groups D and E, and groups E and F(P= 0.122, P = 0.084, P = 0.192, respectively). Significant differences on Fmax were found between any other two groups(P<0.05). There was significant positive correlation between Fmax and the volume of PMMA(P<0.05). The destructions of blocks were slight in group A and most severe in group F, and the destructions of blocks were increased from groups A to F. Conclusions PMMA can significantly enhance stability of pedicle screw in osteoporosis, and the screw stability is increased with the increment on the volume of PMMA. Within a certain range, nevertheless, to increase the volume of PMMA does not significantly improve the screw stability of the screw, but will increase the risk of PMMA leakage. In this study, injection of 3 ml PMMA is considered the preferred choice.