Teriparatide increases the insertional torque of pedicle screws during fusion surgery in patients with postmenopausal osteoporosis
Teriparatide increases the insertional torque of pedicle screws during fusion surgery in patients with postmenopausal osteoporosis
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DOI：
10.3171/2014.5.spine13656
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发表时间：
2014-09-01
影响因子：
2.8
通讯作者：
Takaso, Masashi
中科院分区：
文献类型：
--
作者：
Inoue, Gen;Ueno, Masaki;Takaso, Masashi
Object.本研究的目的是检查术前teriparbital治疗的有效性，增加椎弓根螺钉的插入扭矩在融合手术中的绝经后妇女腰椎间盘突出症。对29例绝经后骨质疏松症妇女（年龄65-82岁，平均72.2岁）进行胸椎和/或腰椎融合手术。根据术前是否接受特立哌酮治疗（n = 13）或未接受特立哌酮治疗（n = 16），将患者分为2组。在特立帕肽治疗组中，患者接受术前特立帕肽治疗，每日（20 μ g/天，n = 7）或每周（56.5 μ g/周，n = 6）注射，平均61.4天，最少31天。在手术过程中，测量了从T-7到L-5插入的212枚螺钉的插入扭矩，并在两组之间进行了比较。同时，还研究了旋入扭矩与术前经皮穿刺治疗时间的相关性。经皮股骨头置换术组的平均插入扭矩值为1.28 +/- 0.42 Nm，显著高于对照组（1.08 +/- 0.52 Nm，p < 0.01）。在平均插入扭矩值（分别为1.34 +/- 0.50 Nm和1.18 +/- 0.43 Nm，p = 0.07）方面，每日和每周一次的三联疗法组之间没有显著差异。旋入扭矩与术前治疗时间无相关性（r（2）= 0.05，p < 0.01）。术前至少1个月开始注射特立帕鲁肽可有效增加绝经后骨质疏松患者术中椎弓根螺钉的插入扭矩。术前单侧椎弓根治疗可能是融合手术时最大限度地将椎弓根螺钉固定在骨上的一种选择。
Object. The object of this study was to examine the efficacy of preoperative teriparatide treatment for increasing the insertional torque of pedicle screws during fusion surgery in postmenopausal women with osteoporosis.Methods. Fusion surgery for the thoracic and/or lumbar spine was performed in 29 postmenopausal women with osteoporosis aged 65-82 years (mean 72.2 years). The patients were divided into 2 groups based on whether they were treated with teriparatide (n = 13) or not (n = 16) before the surgery. In the teriparatide-treated group, patients received preoperative teriparatide therapy as either a daily (20 mu g/day, n = 7) or a weekly (56.5 mu g/week, n = 6) injection for a mean of 61.4 days and a minimum of 31 days. During surgery, the insertional torque was measured in 212 screws inserted from T-7 to L-5 and compared between the 2 groups. The correlation between the insertional torque and the duration of preoperative teriparatide treatment was also investigated.Results. The mean insertional torque value in the teriparatide group was 1.28 +/- 0.42 Nm, which was significantly higher than in the control group (1.08 +/- 0.52 Nm, p < 0.01). There was no significant difference between the daily and the weekly teriparatide groups with respect to mean insertional torque value (1.34 +/- 0.50 Nm and 1.18 +/- 0.43 Nm, respectively, p = 0.07). There was negligible correlation between insertional torque and duration of preoperative teriparatide treatment (r(2) = 0.05, p < 0.01).Conclusions. Teriparatide injections beginning at least 1 month prior to surgery were effective in increasing the insertional torque of pedicle screws during surgery in patients with postmenopausal osteoporosis. Preoperative teriparatide treatment might be an option for maximizing the purchase of the pedicle screws to the bone at the time of fusion surgery.