Comparison of Implant Failure between Cement Augmented Cannulated Pedicle Screws and Solid Pedicle Screws and Associated Risk Factors in Lumbar Fusion Surgery: A Pilot Study
Comparison of Implant Failure between Cement Augmented Cannulated Pedicle Screws and Solid Pedicle Screws and Associated Risk Factors in Lumbar Fusion Surgery: A Pilot Study
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腰椎融合手术中水泥增强空心椎弓根螺钉和实心椎弓根螺钉植入失败及相关危险因素的比较：一项初步研究
DOI：
10.4184/jkss.2020.27.3.89
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Chang
中科院分区：
文献类型：
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作者：
S. Choi;J. M. Hur;Jooyoung You;Chang
研究设计：回顾性初步研究目的：根据在腰椎融合手术中使用实心椎弓根螺钉或骨水泥增强空心椎弓根螺钉，比较和分析植入物失效的发生率和风险因素。文献综述总结：在先前的研究中，发现骨水泥增强空心椎弓根螺钉的使用可提高拔出强度，并降低骨质疏松患者植入物失效的风险。然而，尚未确定植入物失效的临床风险因素。材料与方法：2016年1月至2018年12月，177例脊柱骨折和退行性胸腰椎疾病患者被纳入一项回顾性研究，患者接受了使用椎弓根螺钉的脊柱融合手术。118例患者使用实心椎弓根螺钉，59例患者使用骨水泥加固空心椎弓根螺钉。在随访期间，进行简单的X线摄影和计算机断层扫描，以评估植入物失败的病例，包括椎弓根螺钉松动、移位和拔出，并分析植入物失败的风险因素。随访期间，在21例患者（11.9%，21/177）中观察到植入物失效。在21例植入失败的患者中，实心椎弓根螺钉组有18例（15.3%，18/118），骨水泥增强空心椎弓根螺钉组有3例（5.1%，3/59）。差异有统计学意义（p<0.05）。年龄65岁以上、骨质疏松、自身免疫性疾病（类风湿性关节炎、系统性红斑狼疮等），慢性肾脏疾病和类固醇使用（<0.05）在经历植入失败的患者中统计学上显著更常见。在多元逻辑回归分析中，年龄超过65岁（比值比，4.47; p=0.032）、骨质疏松症（比值比，3.68; p=0.017）、自身免疫性疾病（比值比，3.59; p=0.039）和慢性肾脏疾病（比值比，4.67; p=0.043）是植入物失败的统计学显著风险因素。结论：接受胸腰椎融合术的患者年龄超过65岁，患有骨质疏松症、慢性肾脏疾病或自身免疫性疾病，植入物失败率较高。使用骨水泥加固空心椎弓根螺钉可能是一种有效的方法，可以显著降低具有这些风险因素的患者发生植入物失效的可能性。
Study Design: Retrospective pilot study Objectives: To compare and analyze the rate and risk factors of implant failure according to the use of solid pedicle screws or cement augmented cannulated pedicle screws in lumbar fusion surgery. Summary of Literature Review: In previous studies, the use of cement augmented cannulated pedicle screws was found to improve the pull-out strength and to reduce the risk of implant failure in patients with osteoporosis. However, the clinical risk factors for implant failure have not been established. Materials and Methods: From January 2016 to December 2018, 177 patients with spine fracture and degenerative thoracolumbar disease were included in a retrospective study, and the patients underwent spinal fusion surgery using pedicle screws. Solid pedicle screws were used in 118 patients and cement augmented cannulated pedicle screws were used in 59 patients. During the follow-up period, simple radiography and computed tomography were performed to evaluate cases of implant failure, including pedicle screw loosening, migration, and pull-out, and to analyze risk factors for implant failure. Implant failures were observed in 21 patients (11.9%, 21/177) during the follow-up period. Of the 21 patients with implant failure, 18 were in the solid pedicle screw group (15.3%, 18/118), and 3 patients were in the cement augmented cannulated pedicle screw group (5.1%, 3/59). The difference was statistically significant (p<0.05). Age over 65 years, osteoporosis, autoimmune disease (rheumatoid arthritis, systemic lupus erythematosus, etc.), chronic kidney disease, and steroid use (<0.05) were statistically significantly more common in patients who experienced implant failure. In a multiple logistic regression analysis, age over 65 (odds ratio, 4.47; p=0.032), osteoporosis (odds ratio, 3.68; p=0.017), autoimmune disease (odds ratio, 3.59; p=0.039), and chronic kidney disease (odds ratio, 4.67; p=0.043) were statistically significant risk factors for implant failure. Conclusions: Patients underwent thoracolumbar fusion who were over 65 years of age, had osteoporosis, chronic kidney disease, or autoimmune disease showed a high implant failure rate. The use of cement augmented cannulated pedicle screws might be an effective method to significantly decrease the likelihood of implant failure in patients with these risk factors.