使用皮质骨轨迹预测椎弓根螺钉固定时螺钉轨迹的区域Hounsfield单位测量：一项回顾性队列研究。
Regional Hounsfield unit measurement of screw trajectory for predicting pedicle screw fixation using cortical bone trajectory: a retrospective cohort study.
作者信息
Matsukawa Keitaro, Abe Yuichiro, Yanai Yoshihide, Yato Yoshiyuki
机构信息
Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan.
Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Eniwa, Hokkaido, Japan.
出版信息
Acta Neurochir (Wien). 2018 Feb;160(2):405-411. doi: 10.1007/s00701-017-3424-5. Epub 2017 Dec 19.
BACKGROUND
The sufficiency of screw anchoring is a critical factor for achieving successful spinal fusion; however, no reliable method for predicting pedicle screw fixation has been established. Recently, Hounsfield units (HU) obtained from computed tomography (CT) was developed as a new reliable tool to determine the bone quality. The purpose of the present study was to demonstrate the utility of regional HU measurement of the screw trajectory to predict the primary and long-term fixation strength of pedicle screws.
METHOD
The insertional torque of pedicle screws using the cortical bone trajectory technique was measured intraoperatively in 92 consecutive patients who underwent single-level posterior lumbar interbody fusion. The cylindrical area of each screw was plotted on the preoperative CT image by precisely confirming the screw position, and the screw trajectory was measured in HU. First, three parameters: the bone mineral density (BMD) of the femoral neck and lumbar vertebrae, and regional HU values of the screw trajectory, were correlated with the insertional torque and compared among three groups. Next, pedicle screw loosening was evaluated by postoperative CT obtained 12 months after surgery, and clinical and imaging data were analyzed to assess whether regional HU values could be used as a predictor of screw loosening.
RESULTS
Regional HU values of the screw trajectory (r = 0.75, p < 0.001) had stronger correlation with the insertional torque than the femoral BMD (r = 0.59, p < 0.001) and lumbar BMD (r = 0.55, p < 0.001). The incidence of screw loosening was 4.6% (16/351). Multivariate logistic regression analysis revealed that regional HU value (odds ratio = 0.70; 95% confidence interval = 0.56-0.84; p = 0.018) was an independent risk factor significantly affected screw loosening.
CONCLUSIONS
Regional HU values of the screw trajectory could be a strong predictor of both primary and long-term screw fixation in vivo.
背景
螺钉锚固的充分性是实现成功脊柱融合的关键因素；然而，尚未建立可靠的预测椎弓根螺钉固定的方法。最近，计算机断层扫描（CT）获得的亨氏单位（HU）被开发为一种确定骨质量的新型可靠工具。本研究的目的是证明测量螺钉轨迹区域的HU以预测椎弓根螺钉的初始和长期固定强度的实用性。
方法
在92例连续接受单节段后路腰椎椎间融合术的患者中，术中测量采用皮质骨轨迹技术置入椎弓根螺钉的插入扭矩。通过精确确认螺钉位置，将每个螺钉的圆柱区域绘制在术前CT图像上，并测量螺钉轨迹的HU值。首先，将三个参数：股骨颈和腰椎的骨密度（BMD）以及螺钉轨迹的区域HU值，与插入扭矩进行相关性分析，并在三组之间进行比较。其次，通过术后12个月获得的CT评估椎弓根螺钉松动情况，并分析临床和影像学数据，以评估区域HU值是否可作为螺钉松动的预测指标。
结果
螺钉轨迹的区域HU值（r = 0.75，p < 0.001）与插入扭矩的相关性比股骨BMD（r = 0.59，p < 0.001）和腰椎BMD（r = 0.55，p < 0.001）更强。螺钉松动的发生率为4.6%（16/351）。多因素逻辑回归分析显示，区域HU值（优势比 = 0.70；95%置信区间 = 0.56 - 0.84；p = 0.018）是显著影响螺钉松动的独立危险因素。
结论
螺钉轨迹的区域HU值可能是体内螺钉初始和长期固定的有力预测指标。
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