Bullmann V, Liljenqvist U R, Rödl R, Schulte T L
Klinik und Poliklinik für Allgemeine Orthopädie und Tumororthopädie, Universitätsklinikum Münster, Albert Schweitzer Strasse 33, 48149, Münster, Deutschland.
Orthopade. 2010 Jul;39(7):673-8. doi: 10.1007/s00132-010-1602-8.
Severe osteoporosis is a serious problem in the instrumentation during spine surgery. Besides kyphosis, adjacent vertebral fractures and of course pedicle screw loosening and implant pullout are frequent challenges in instrumentation of the osteoporotic spine. In addition to screw diameter and length, bone mineral density has the most important impact on the stability of a pedicle screw. In cases of severe osteoporosis cement augmentation increases the stability of a pedicle screw. Pullout force can be increased with augmentation by 96-278%. Nowadays, there are two different procedures for augmentation: cement augmentation of the vertebra before inserting the screw into the soft, fresh cement or augmentation via a perforated screw that has already been inserted.The main problem in augmentation techniques are cement leakages. In both techniques leakages may occur. The problem of leakages seems to be less severe in the augmentation technique via the perforated screw, because cement application can be stopped immediately if the onset of leakage is noticed. Even surgical revision of cement augmented screws is not a major clinical problem based on recent biomechanical studies. The revision screw can be chosen 1 mm thicker and can be cement augmented again without technical problems.
严重骨质疏松是脊柱手术器械操作中的一个严重问题。除了脊柱后凸，相邻椎体骨折，当然还有椎弓根螺钉松动和植入物拔出，都是骨质疏松脊柱器械操作中常见的挑战。除了螺钉直径和长度外，骨密度对椎弓根螺钉的稳定性影响最大。在严重骨质疏松的情况下，骨水泥强化可增加椎弓根螺钉的稳定性。通过强化，拔出力可提高96%至278%。如今，有两种不同的强化方法：在将螺钉插入柔软、新鲜的骨水泥之前对椎体进行骨水泥强化，或通过已插入的多孔螺钉进行强化。强化技术的主要问题是骨水泥渗漏。在这两种技术中都可能发生渗漏。通过多孔螺钉进行强化的技术中，渗漏问题似乎不那么严重，因为如果发现渗漏开始，可以立即停止注入骨水泥。根据最近的生物力学研究，即使是对骨水泥强化螺钉进行手术翻修也不是一个主要的临床问题。翻修螺钉可以选择粗1毫米，并且可以再次进行骨水泥强化，不会有技术问题。
