Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, 510000, People's Republic of China.
Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510020, People's Republic of China.
BMC Surg. 2023 Nov 18;23(1):354. doi: 10.1186/s12893-023-02235-9.
This study aimed to compare whether Calcium phosphate cement (CPC) promotes the stability of osteoporotic lumbar pedicle screw by enhancer-injecters with different number of holes.
Through a self-designed bone cement injection device, the pedicle screw canal was strengthened with calcium phosphate bone cement, and divided into 4-hole group, 6-hole group, 8-hole group, straight pore group and the control group. The screw was inserted into the mechanical test module, the Maximum insertion torque and Maximum axial pull-out strength were recorded, and the distribution of calcium phosphate bone cement was analyzed by CT and X-ray. The data results were analyzed using SPSS19.0 statistical software package.
The distribution of bone cement in different reinforcement groups was different and showed regularity. The bone cement in the 4-hole group was roughly located in the head 1/3 of the screw, the 6-hole group was located in the middle 1/3 of the screw, and the 8-hole group was located in the caudal 1/3 of the screw. Compared with the control group, the maximum axial pull-out force of screws in the lateral hole and full screw tunnel reinforcement group was significantly increased. There was no significant difference between the 4-hole, 6-hole and straight pore groups. There was no difference in the screw-in torque between the reinforcement groups, and they all increased significantly compared with the control group, and the difference was statistically significant. After the screw was pulled out, the interface between the bone cement and the polyurethane material was fractured, and a tight package was formed with the screw.
Enhancer syringes with different hole numbers combined with CPC bone cement injection can significantly increase the maximum screw pull-out force. The 8-hole group has a smaller pull-out force and is relatively prone to leakage of reinforcing material, which lacks safety in use. The local reinforcement of 4-hole and 6-hole sheath can play a similar role to that of total nail tunnel reinforcement.
本研究旨在比较不同孔数增强注射器对磷酸钙骨水泥（CPC）增强骨质疏松性腰椎椎弓根螺钉稳定性的作用。
通过自行设计的骨水泥注射装置，在磷酸钙骨水泥中强化椎弓根螺钉通道，并将其分为 4 孔组、6 孔组、8 孔组、直孔组和对照组。将螺钉插入机械测试模块，记录最大插入扭矩和最大轴向拔出强度，并通过 CT 和 X 射线分析磷酸钙骨水泥的分布。使用 SPSS19.0 统计软件包分析数据结果。
不同增强组的骨水泥分布不同，呈现出一定的规律性。4 孔组的骨水泥大致位于螺钉头部 1/3，6 孔组位于螺钉中部 1/3，8 孔组位于螺钉尾部 1/3。与对照组相比，侧孔和全螺钉隧道增强组螺钉的最大轴向拔出力显著增加。4 孔、6 孔和直孔组之间无显著差异。增强组的螺钉拧入扭矩无差异，均较对照组显著增加，差异有统计学意义。螺钉拔出后，骨水泥与聚氨酯材料的界面发生断裂，与螺钉形成紧密包裹。
不同孔数的增强注射器结合 CPC 骨水泥注射可显著增加最大螺钉拔出力。8 孔组拔出力较小，增强材料渗漏风险相对较高，使用安全性不足。4 孔和 6 孔鞘局部增强可发挥与全钉隧道增强相似的作用。
