Inoue Gen, Ueno Masaki, Nakazawa Toshiyuki, Imura Takayuki, Saito Wataru, Uchida Kentaro, Ohtori Seiji, Toyone Tomoaki, Takahira Naonobu, Takaso Masashi
Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa;
J Neurosurg Spine. 2014 Sep;21(3):425-31. doi: 10.3171/2014.5.SPINE13656. Epub 2014 Jun 6.
The object of this study was to examine the efficacy of preoperative teriparatide treatment for increasing the insertional torque of pedicle screws during fusion surgery in postmenopausal women with osteoporosis.
Fusion surgery for the thoracic and/or lumbar spine was performed in 29 postmenopausal women with osteoporosis aged 65-82 years (mean 72.2 years). The patients were divided into 2 groups based on whether they were treated with teriparatide (n = 13) or not (n = 16) before the surgery. In the teriparatide-treated group, patients received preoperative teriparatide therapy as either a daily (20 μg/day, n = 7) or a weekly (56.5 μg/week, n = 6) injection for a mean of 61.4 days and a minimum of 31 days. During surgery, the insertional torque was measured in 212 screws inserted from T-7 to L-5 and compared between the 2 groups. The correlation between the insertional torque and the duration of preoperative teriparatide treatment was also investigated.
The mean insertional torque value in the teriparatide group was 1.28 ± 0.42 Nm, which was significantly higher than in the control group (1.08 ± 0.52 Nm, p < 0.01). There was no significant difference between the daily and the weekly teriparatide groups with respect to mean insertional torque value (1.34 ± 0.50 Nm and 1.18 ± 0.43 Nm, respectively, p = 0.07). There was negligible correlation between insertional torque and duration of preoperative teriparatide treatment (r(2) = 0.05, p < 0.01).
Teriparatide injections beginning at least 1 month prior to surgery were effective in increasing the insertional torque of pedicle screws during surgery in patients with postmenopausal osteoporosis. Preoperative teriparatide treatment might be an option for maximizing the purchase of the pedicle screws to the bone at the time of fusion surgery.
本研究的目的是探讨术前使用特立帕肽治疗对增加绝经后骨质疏松症女性融合手术中椎弓根螺钉插入扭矩的疗效。
对29例年龄在65 - 82岁（平均72.2岁）的绝经后骨质疏松症女性进行胸段和/或腰段脊柱融合手术。根据术前是否接受特立帕肽治疗（n = 13）将患者分为两组，未接受治疗的为另一组（n = 16）。在特立帕肽治疗组中，患者接受术前特立帕肽治疗，每日注射（20μg/天，n = 7）或每周注射（56.5μg/周，n = 6），平均治疗61.4天，最短31天。手术期间，测量从T - 7至L - 5插入的212枚螺钉的插入扭矩，并在两组之间进行比较。还研究了插入扭矩与术前特立帕肽治疗持续时间之间的相关性。
特立帕肽组的平均插入扭矩值为1.28±0.42 Nm，显著高于对照组（1.08±0.52 Nm，p < 0.01）。每日和每周使用特立帕肽组之间的平均插入扭矩值无显著差异（分别为1.34±0.50 Nm和1.18±0.43 Nm，p = 0.07）。插入扭矩与术前特立帕肽治疗持续时间之间的相关性可忽略不计（r(2) = 0.05，p < 0.01）。
术前至少1个月开始注射特立帕肽可有效增加绝经后骨质疏松症患者手术中椎弓根螺钉的插入扭矩。术前特立帕肽治疗可能是在融合手术时使椎弓根螺钉与骨的固定最大化的一种选择。
