使用皮质骨轨迹技术对椎弓根螺钉置入过程中的插入扭矩进行体内分析。
In vivo analysis of insertional torque during pedicle screwing using cortical bone trajectory technique.
作者信息
Matsukawa Keitaro, Yato Yoshiyuki, Kato Takashi, Imabayashi Hideaki, Asazuma Takashi, Nemoto Koichi
机构信息
*Department of Orthopaedic Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan; and †Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan.
出版信息
Spine (Phila Pa 1976). 2014 Feb 15;39(4):E240-5. doi: 10.1097/BRS.0000000000000116.
STUDY DESIGN
The insertional torque of pedicle screws using the cortical bone trajectory (CBT) was measured in vivo.
OBJECTIVE
To investigate the effectiveness of the CBT technique by measurement of the insertional torque.
SUMMARY OF BACKGROUND DATA
The CBT follows a mediolateral and caudocephalad directed path, engaging with cortical bone maximally from the pedicle to the vertebral body. Some biomechanical studies have demonstrated favorable characteristics of the CBT technique in cadaveric lumbar spine. However, no in vivo study has been reported on the mechanical behavior of this new trajectory.
METHODS
The insertional torque of pedicle screws using CBT and traditional techniques were measured intraoperatively in 48 consecutive patients. A total of 162 screws using the CBT technique and 36 screws using the traditional technique were compared. In 8 of 48 patients, the side-by-side comparison of 2 different insertional techniques for each vertebra were performed, which formed the H group. In addition, the insertional torque was correlated with bone mineral density.
RESULTS
The mean maximum insertional torque of CBT screws and traditional screws were 2.49 ± 0.99 Nm and 1.24 ± 0.54 Nm, respectively. The CBT screws showed 2.01 times higher torque and the difference was significant between the 2 techniques (P < 0.01). In the H group, the insertional torque were 2.71 ± 1.36 Nm in the CBT screws and 1.58 ± 0.44 Nm in the traditional screws. The CBT screws demonstrated 1.71 times higher torque and statistical significance was achieved (P < 0.01). Positive linear correlations between maximum insertional torque and bone mineral density were found in both technique, the correlation coefficient of traditional screws (r = 0.63, P < 0.01) was higher than that of the CBT screws (r = 0.59, P < 0.01).
CONCLUSION
The insertional torque using the CBT technique is about 1.7 times higher than the traditional technique.
LEVEL OF EVIDENCE
研究设计
在体内测量使用皮质骨轨迹（CBT）的椎弓根螺钉的插入扭矩。
目的
通过测量插入扭矩来研究CBT技术的有效性。
背景数据总结
CBT遵循中外侧和尾头方向的路径，从椎弓根到椎体最大程度地与皮质骨接触。一些生物力学研究已证明CBT技术在尸体腰椎中具有良好特性。然而，尚未有关于这种新轨迹力学行为的体内研究报道。
方法
在48例连续患者术中测量使用CBT和传统技术的椎弓根螺钉的插入扭矩。共比较了162枚使用CBT技术的螺钉和36枚使用传统技术的螺钉。在48例患者中的8例中，对每个椎体的两种不同插入技术进行了并排比较，形成H组。此外，将插入扭矩与骨密度进行相关性分析。
结果
CBT螺钉和传统螺钉的平均最大插入扭矩分别为2.49±0.99 Nm和1.24±0.54 Nm。CBT螺钉的扭矩高出2.01倍，两种技术之间的差异具有统计学意义（P<0.01）。在H组中，CBT螺钉的插入扭矩为2.71±1.36 Nm，传统螺钉为1.58±0.44 Nm。CBT螺钉的扭矩高出1.71倍，差异具有统计学意义（P<0.01）。两种技术中最大插入扭矩与骨密度均呈正线性相关，传统螺钉的相关系数（r = 0.63，P<0.01）高于CBT螺钉（r = 0.59，P<0.01）。
结论
使用CBT技术的插入扭矩比传统技术高约1.7倍。
证据水平
2级。
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