Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
BMC Musculoskelet Disord. 2022 Feb 28;23(1):186. doi: 10.1186/s12891-022-05107-0.
When choosing S1 as the lowest level of instrumentation, there are many complications may come out such as S1 screw loosening. Facing this problem, there has been various techniques for the protection of S1 screw including sacropelvic fixation, bicortical or tricortical insertion of S1 screw.
This study aimed to explore the risk factors for the S1 screw loosening, then to demonstrate the relationship between S1 screw loosening and postoperative outcome for patients with degenerative lumbar scoliosis (DLS).
Patients who underwent lumbosacral fixation for DLS were evaluated retrospectively. They were divided into two groups according to the S1 pedicle screw at the follow-up. Age, gender, bone mineral density, body mass index, history of smoking, the number of instrumented levels, comorbidities, complications and radiological parameters were collected. We established logistic regression analysis to determine independent risk factors for S1 screw loosening and multiple linear regression to identify whether S1 screw loosening would influence postoperative clinical outcome.
S1 screw loosening rate was up to 41.0% (32/78). Patients were older in the S1 screw loosening group than those in the control group (P < 0.05). Compared with the control group, the rate of osteoporosis was higher in screw loosening group than that in the control group (P < 0.05). Older age and osteoporosis were independent risk factors for S1 screw loosening (P < 0.05). In the screw loosening group, the rate of hypertension was higher than that in the control group (P < 0.05). The relationship of S1 screw loosening and ODI was not significant in the multiple linear regression (P > 0.05). The clinical outcome was similar in the S1 screw loosening group and control group (P > 0.05).
Older age and osteoporosis are independent risk factors for the S1 screw loosening. Patients with complication of S1 screw loosening are not always along with worse clinical outcome. We should consider potential benefit, complications and medical cost when choosing the lowest instrumented vertebrae for patients with DLS.
当选择 S1 作为最低水平的仪器时，可能会出现许多并发症，例如 S1 螺钉松动。针对这个问题，已经有多种技术用于保护 S1 螺钉，包括骶髂固定、S1 螺钉的双皮质或三皮质插入。
本研究旨在探讨 S1 螺钉松动的危险因素，并探讨 S1 螺钉松动与退行性腰椎侧凸（DLS）患者术后结果的关系。
回顾性评估接受腰骶固定治疗 DLS 的患者。根据随访时 S1 椎弓根螺钉的情况，将患者分为两组。收集年龄、性别、骨密度、体重指数、吸烟史、器械化水平数、合并症、并发症和影像学参数。我们建立了逻辑回归分析来确定 S1 螺钉松动的独立危险因素，并进行多元线性回归以确定 S1 螺钉松动是否会影响术后临床结果。
S1 螺钉松动率高达 41.0%（32/78）。S1 螺钉松动组患者的年龄大于对照组（P<0.05）。与对照组相比，螺钉松动组骨质疏松症的发生率高于对照组（P<0.05）。年龄较大和骨质疏松症是 S1 螺钉松动的独立危险因素（P<0.05）。在螺钉松动组，高血压的发生率高于对照组（P<0.05）。多元线性回归中 S1 螺钉松动与 ODI 之间的关系不显著（P>0.05）。S1 螺钉松动组与对照组的临床结果相似（P>0.05）。
年龄较大和骨质疏松症是 S1 螺钉松动的独立危险因素。S1 螺钉松动并发症患者的临床结果不一定更差。在为 DLS 患者选择最低固定节段时，应考虑潜在的益处、并发症和医疗费用。
