CAJ | 학술논문

背景：老年性骨质疏松症患者由于骨质相对比较脆弱，使得椎弓根螺钉固定能力相对较差。当前，临床上使用骨水泥强化椎弓螺钉的方法能够提高螺钉固定能力，但是患者治疗时水泥渗漏以及螺钉取出困难成为其解决问题。目的：研制新型可灌注骨水泥椎弓根螺钉，探讨其生物力学特性和安全性及实用性，为临床骨质疏松脊柱疾病患者治疗提供依据。方法：选取南京中医大学附属医院2013年12月至2015年1月采集的6具73例完整湿润脊柱标本资料进行分析，标本中共有42个椎体。入选椎体在一侧椎弓根置入可灌注骨水泥椎弓根螺钉后采用骨水泥推杆和灌注筒在X射线辅助下向其内灌注2 mL骨水泥设为实验组，对侧椎弓根置入常规螺钉作为对照组，观察骨水泥弥散情况。结果与结论：骨水泥由稀糊状期进入团状初期的时间为三四分钟；糊状期骨水泥采用注射器抽取注入灌注筒中更为方便；灌注筒和螺钉尾部的螺纹连接方便、紧密，无渗漏；推杆可以提供足够的灌注力；骨水泥在中空和侧孔处弥散出螺钉，侧孔排列规律性强，且各侧孔间距相等；常规椎弓根螺钉极限强度、极限位移显著高于新型可灌注骨水泥椎弓根螺钉(P <0.05)；常规椎弓根螺钉屈服载荷以及屈服位移显著低于新型可灌注骨水泥椎弓根螺钉(P <0.05)；骨水泥在可灌注骨水泥螺钉周围弥散分布规则，骨水泥由4排侧孔向不同的方向弥散入周围骨松质，且与相邻骨水泥团融合；新型可灌注骨水泥螺钉轴向拔出力较对照组增加了114%(P <0.05)；新型可灌注骨水泥螺钉最大旋出力矩，显著高于对照组(P <0.05)。结果证实，新型设计的可灌注骨水泥椎弓根螺钉，结合骨水泥推杆和灌注筒应用更加方便，能够有效控制骨水泥渗漏，提高椎弓根的稳定性且能在骨质疏松患者中广为使用。揹景：老年性骨質疏鬆癥患者由于骨質相對比較脆弱，使得椎弓根螺釘固定能力相對較差。噹前，臨床上使用骨水泥彊化椎弓螺釘的方法能夠提高螺釘固定能力，但是患者治療時水泥滲漏以及螺釘取齣睏難成為其解決問題。目的：研製新型可灌註骨水泥椎弓根螺釘，探討其生物力學特性和安全性及實用性，為臨床骨質疏鬆脊柱疾病患者治療提供依據。方法：選取南京中醫大學附屬醫院2013年12月至2015年1月採集的6具73例完整濕潤脊柱標本資料進行分析，標本中共有42箇椎體。入選椎體在一側椎弓根置入可灌註骨水泥椎弓根螺釘後採用骨水泥推桿和灌註筒在X射線輔助下嚮其內灌註2 mL骨水泥設為實驗組，對側椎弓根置入常規螺釘作為對照組，觀察骨水泥瀰散情況。結果與結論：骨水泥由稀糊狀期進入糰狀初期的時間為三四分鐘；糊狀期骨水泥採用註射器抽取註入灌註筒中更為方便；灌註筒和螺釘尾部的螺紋連接方便、緊密，無滲漏；推桿可以提供足夠的灌註力；骨水泥在中空和側孔處瀰散齣螺釘，側孔排列規律性彊，且各側孔間距相等；常規椎弓根螺釘極限彊度、極限位移顯著高于新型可灌註骨水泥椎弓根螺釘(P <0.05)；常規椎弓根螺釘屈服載荷以及屈服位移顯著低于新型可灌註骨水泥椎弓根螺釘(P <0.05)；骨水泥在可灌註骨水泥螺釘週圍瀰散分佈規則，骨水泥由4排側孔嚮不同的方嚮瀰散入週圍骨鬆質，且與相鄰骨水泥糰融閤；新型可灌註骨水泥螺釘軸嚮拔齣力較對照組增加瞭114%(P <0.05)；新型可灌註骨水泥螺釘最大鏇齣力矩，顯著高于對照組(P <0.05)。結果證實，新型設計的可灌註骨水泥椎弓根螺釘，結閤骨水泥推桿和灌註筒應用更加方便，能夠有效控製骨水泥滲漏，提高椎弓根的穩定性且能在骨質疏鬆患者中廣為使用。
배경：노년성골질소송증환자유우골질상대비교취약，사득추궁근라정고정능력상대교차。당전，림상상사용골수니강화추궁라정적방법능구제고라정고정능력，단시환자치료시수니삼루이급라정취출곤난성위기해결문제。목적：연제신형가관주골수니추궁근라정，탐토기생물역학특성화안전성급실용성，위림상골질소송척주질병환자치료제공의거。방법：선취남경중의대학부속의원2013년12월지2015년1월채집적6구73례완정습윤척주표본자료진행분석，표본중공유42개추체。입선추체재일측추궁근치입가관주골수니추궁근라정후채용골수니추간화관주통재X사선보조하향기내관주2 mL골수니설위실험조，대측추궁근치입상규라정작위대조조，관찰골수니미산정황。결과여결론：골수니유희호상기진입단상초기적시간위삼사분종；호상기골수니채용주사기추취주입관주통중경위방편；관주통화라정미부적라문련접방편、긴밀，무삼루；추간가이제공족구적관주력；골수니재중공화측공처미산출라정，측공배렬규률성강，차각측공간거상등；상규추궁근라정겁한강도、겁한위이현저고우신형가관주골수니추궁근라정(P <0.05)；상규추궁근라정굴복재하이급굴복위이현저저우신형가관주골수니추궁근라정(P <0.05)；골수니재가관주골수니라정주위미산분포규칙，골수니유4배측공향불동적방향미산입주위골송질，차여상린골수니단융합；신형가관주골수니라정축향발출력교대조조증가료114%(P <0.05)；신형가관주골수니라정최대선출력구，현저고우대조조(P <0.05)。결과증실，신형설계적가관주골수니추궁근라정，결합골수니추간화관주통응용경가방편，능구유효공제골수니삼루，제고추궁근적은정성차능재골질소송환자중엄위사용。
BACKGROUND:In senile osteoporosis patients, capacity of pedicle screw fixation is relatively poor due to fragile bone substance. Currently, augmentation of pedicle screw fixation with bone cement can improve the ability of screw fixation, but bone cement leakage and difficulties in screw removal become the problem to be solved. OBJECTIVE:To develop a novel pourable pedicle bone cement and to investigate its biomechanical properties, safety and practicality, thus providing the basis for clinical treatment of osteoporosis and spinal diseases. <br> METHODS:Six cases of complete wetting spines were colected at the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from December 2013 to January 2015, including 42 vertebrae. Pedicle screw fixation with X-ray assisted bone cement injection (2 mL) was performed unilateraly as experimental group, and conventional pedicle screw fixation was done contralateraly as control group. Bone cement dispersion was observed in the two groups. RESULTS AND CONCLUSION:It was 3-4 minutes for bone cement to agglomerate. Injection of bone cement paste into the infusion cylinder using a syringe was more convenient. The cylinder was connected tightly with the tail-end of the screw with no leakage. The push bar could provide sufficient perfusion force. Bone cement dispersion was found in the holow part and side holes of the screw. Side holes arranged regularly, and the hole pitch was equal. Compared with the control group, the yield load and yield displacement were significantly higher in the experimental group (P < 0.05), but the ultimate strength and ultimate displacement were significantly lower in the experimental group (P < 0.05). Bone cement around the pourable cement screw dispersed regularly, which was diffused into the surround cancelous bone and integrated with adjacent bone cement mass. The axial withdrawal force was increased by 114% in the experimental group compared with the control group (P < 0.05). The maximum rotary torque was significantly higher in the experimental group than the control group (P< 0.05). These finding suggest that the new pourable cement screw combined with bone cement putter and infusion cylinder is applied more convenient, can effectively control the leakage of bone cement, and can improve the stability of the pedicle in osteoporosis patients, which has been widely used.