Feasibility of using tapping torque during lumbar pedicle screw insertion to predict screw fixation strength
Feasibility of using tapping torque during lumbar pedicle screw insertion to predict screw fixation strength
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DOI：
10.1016/j.jos.2019.05.009
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发表时间：
2020-05-01
影响因子：
1.7
通讯作者：
Chiba, Kazuhiro
中科院分区：
文献类型：
--
作者：
Matsukawa, Keitaro;Yato, Yoshiyuki;Chiba, Kazuhiro
背景：坚固的椎弓根螺钉固定是获得成功脊柱融合的必备条件；然而，目前还没有可靠的方法预测螺钉植入前的固定情况。本研究的目的是探讨测量攻丝扭矩预测椎弓根螺钉固定的有效性。方法：首先，用不同密度的聚氨酯泡沫塑料测量攻丝扭矩。测量椎弓根螺钉插入过程中的插入扭矩和轴向拔出强度，并比较未攻丝和相同攻丝两组之间的差异。接下来，为了活体研究，使用皮质骨轨迹技术测量了45名连续患者术中腰椎椎弓根螺钉的敲击扭矩和插入扭矩。结果：无论攻丝大小，体外攻丝扭矩与插入扭矩和拔出力矩均呈显著正相关(r=0.98p<；0.001)。体内平均攻丝扭矩为1.48±-0.73Nm，插入扭矩为2.48±1.25Nm(p<；0.001)。攻丝扭矩与攻丝扭矩和两项骨密度参数显著相关，且攻丝扭矩的相关系数(r=0.001)高于股骨颈骨密度(r=0.59，p；0.001)和腰椎骨密度(r=0.39，p；0.001)。结论：攻丝扭矩是椎弓根螺钉固定的可靠预测指标，允许医生在实际置钉前进行修改，以改善骨钉界面的完整性。(C)2019年日本整形外科协会。爱思唯尔出版，版权所有。
Background: Rigid pedicle screw fixation is mandatory for achieving successful spinal fusion; however, there is no reliable method predicting screw fixation before screw insertion. The purpose of the present study was to investigate the efficacy of measurement of tapping torque to predict pedicle screw fixation.Methods: First, different densities of polyurethane foam were used to measure tapping torque. The insertional torque during pedicle screw insertion and axial pullout strength were measured and compared between under-tapped and same-tapped groups. Next, for in vivo study, the tapping and insertional torque of lumbar pedicle screws using the cortical bone trajectory technique were measured intraoperatively in 45 consecutive patients. Then, correlations between tapping torque, the bone mineral density of the femoral neck and lumbar vertebrae, and insertional torque were investigated.Results: Ex vivo tapping torque significantly correlated with the insertional torque and pullout strength regardless of tapping sizes (r = 0.98, p < 0.001). The mean in vivo tapping and insertional torque were 1.48 +/- 0.73 and 2.48 +/- 1.25 Nm, respectively (p < 0.001). Insertional torque significantly correlated with tapping torque and two BMD parameters, and the correlation coefficient of tapping torque (r = 0.83, p < 0.001) was higher than those of femoral neck BMD (r = 0.59, p < 0.001) and lumbar BMD (r = 0.39, p < 0.001).Conclusions: Tapping torque is a reliable predictor of pedicle screw fixation and allows surgeons to improve the integrity of the bone-screw interface by making modification prior to actual screw insertion. (C) 2019 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.