Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, 100700, China.
Department of Honghui-Hospital, Xi'an Jiaotong University, Xi'an, 710054, China.
BMC Musculoskelet Disord. 2024 Jul 5;25(1):516. doi: 10.1186/s12891-024-07627-3.
Sacral screw loosening is a typical complication after internal fixation surgery through the vertebral arch system. Bicortical fixation can successfully prevent screw loosening, and how improving the rate of bicortical fixation is a challenging clinical investigation.
To investigate the feasibility of improving the double corticality of sacral screws and the optimal fixation depth to achieve double cortical fixation by combining the torque measurement method with bare hands.
Ninety-seven cases of posterior lumbar internal fixation with pedicle root system were included in this study. Based on the tactile feedback of the surgeon indicating the expected penetration of the screw into the contralateral cortex of the sacrum, the screws were further rotated by 180°, 360°, or 720°, categorized into the bicortical 180° group, bicortical 360° group, and bicortical 720° group, respectively. Intraoperatively, the torque during screw insertion was recorded. Postoperatively, the rate of double-cortex engagement was evaluated at 7 days, and screw loosening was assessed at 1 year follow-up.
The bicortical rates of the 180° group, 360° group, and 720° group were 66.13%, 91.18% and 93.75%, respectively. There were statistically significant differences between the 180° group and both the 360° and 720° groups (P < 0.05). However, there was no statistically significant difference between the 360° group and the 720° group (P > 0.05).The rates of loosening of sacral screws in the 180° group, 360° group, and 720° group were 20.97%, 7.35% and 7.81%, respectively. There were statistically significant differences between the 180° group and both the 360° and 720° groups (P < 0.05). However, there was no statistically significant difference between the 360° group and the 720° group (P > 0.05). The bicortical 360° group achieved a relatively satisfactory rate of dual cortical purchase while maintaining a lower rate of screw loosening.
Manual insertion of sacral screws with the assistance of a torque measurement device can achieve a relatively satisfactory dual cortical purchase rate while reducing patient hospitalization costs.
骶骨螺钉松动是经椎弓根系统内固定术后的一种典型并发症。双皮质固定可成功预防螺钉松动，如何提高双皮质固定率是一项具有挑战性的临床研究。
探讨结合扭矩测量方法徒手操作以提高骶骨螺钉双皮质性和最佳固定深度，从而实现双皮质固定的可行性。
本研究纳入 97 例后路腰椎经椎弓根系统内固定患者。根据术者触觉反馈，预计螺钉穿透骶骨对侧皮质时，进一步将螺钉旋转 180°、360°或 720°，分别归入双皮质 180°组、双皮质 360°组和双皮质 720°组。术中记录螺钉插入时的扭矩。术后第 7 天评估双皮质接触率，术后 1 年评估螺钉松动率。
180°组、360°组和 720°组的双皮质率分别为 66.13%、91.18%和 93.75%。180°组与 360°组和 720°组之间的差异均有统计学意义（P<0.05）。但 360°组与 720°组之间的差异无统计学意义（P>0.05）。180°组、360°组和 720°组骶骨螺钉松动率分别为 20.97%、7.35%和 7.81%。180°组与 360°组和 720°组之间的差异均有统计学意义（P<0.05）。但 360°组与 720°组之间的差异无统计学意义（P>0.05）。双皮质 360°组在获得相对满意的双皮质固定率的同时，螺钉松动率较低。
在扭矩测量装置辅助下徒手置入骶骨螺钉可获得较为满意的双皮质固定率，同时降低患者住院费用。
