新型模制同种异体移植锚用于处理初次和翻修腰椎手术中骨密度降低的老年患者的螺钉松动问题的早期经验。

IF 1.7 Q2 SURGERY
Gregory M Malham, Dean T Biddau, Thomas A Wells-Quinn, Michael Selby, Geoffrey Rosenberg
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引用次数: 0

摘要

背景:为减少腰椎器械融合术后椎弓根螺钉松动,人们采用了多种策略,但所有策略都有局限性。在这项前瞻性多中心队列研究中,我们评估了骨密度降低的老年患者使用去矿物质骨纤维(DBF)锚具增强椎弓根螺钉的新技术进行初次或翻修融合手术的结果:这项研究纳入了经双能 X 射线吸收测定法证实骨密度降低的老年患者(年龄大于 65 岁),他们需要进行腰椎椎弓根螺钉固定,并在初次或翻修手术中使用 DBF 同种异体移植锚进行补充治疗。通过评估术前计算机断层扫描(CT)扫描(翻修手术)和外科医生在术中插入和取出椎弓根螺钉时的触觉反馈来确定是否需要使用 DBF 固定器。用尺寸测量仪确定椎弓根螺钉空隙直径后,将直径相同的 DBF 锚栓和椎弓根螺钉放入空隙中。术后第2天进行CT扫描以评估椎弓根破损、椎弓根骨折或锚材料挤出情况,术后6个月和12个月进行CT扫描以评估螺钉松动情况。此后,为尽量减少辐射暴露,仅在疼痛复发时进行 CT 扫描:23名患者(79%为女性,平均年龄74岁)接受了50例使用DBF锚增强的腰骶椎椎弓根螺钉手术。大多数手术(n = 18,78%)都是翻修手术,大多数锚都插入了翻修椎弓根螺钉轨迹(n = 33,66%)。第2天的CT扫描显示没有椎弓根破损/骨折或锚栓材料挤出。在平均15个月(12-20个月)的随访期间,没有发现螺钉松动,也没有患者需要进行椎弓根螺钉翻修手术。DBF同种异体移植物未发生任何不良事件:DBF同种异体移植物锚在骨密度降低的女性老年患者翻修手术中用于增强椎弓根螺钉似乎是安全有效的:在临床上,DBF降低了骨密度降低患者的椎弓根螺钉松动率。螺钉松动率的显著降低可减少翻修手术的需求,而翻修手术费用高昂且存在额外风险。DBF增强的骨整合可促进更好的愈合和长期稳定性:3:
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Early Experience With Novel Molded Allograft Anchors for the Management of Screw Loosening in Elderly Patients With Reduced Bone Density in Primary and Revision Lumbar Surgery.

Background: Various strategies have been used to reduce pedicle screw loosening following lumbar instrumented fusion, but all strategies have limitations. In this prospective multicenter cohort study, outcomes of elderly patients with reduced bone density who underwent primary or revision fusion surgery using a novel technique of pedicle screw augmentation with demineralized bone fiber (DBF) anchors were evaluated.

Methods: This study included elderly patients (aged >65 years) with dual-energy x-ray absorptiometry-confirmed reduced bone density who required lumbar pedicle screw fixation and were treated with supplemental DBF allograft anchors during primary or revision surgery. The need for DBF anchors was determined by evaluating preoperative computed tomography (CT) scans (for revision surgery) and by the surgeons' tactile feedback intraoperatively during pedicle screw insertion and removal. After determining the pedicle screw void diameter with a sizing instrument, DBF anchors and pedicle screws of the same diameter were placed into the void. CT scans were obtained on postoperative day 2 to assess pedicle breach, pedicle fracture, or anchor material extrusion and at 6 and 12 months postoperatively to assess screw loosening. Thereafter, to minimize radiation exposure, CT scans were only performed for recurrence of pain.

Results: Twenty-three patients (79% women; mean age, 74 years) received 50 lumbosacral pedicle screws augmented with DBF anchors. Most surgeries (n = 18, 78%) were revisions, and most anchors were inserted into revision pedicle screw trajectories (n = 33, 66%). Day-2 CT scans revealed no pedicle breach/fracture or extrusion of anchor material. During a mean follow-up of 15 months (12-20 months), no screw loosening was detected, and no patient required pedicle screw revision surgery. There were no adverse events attributable to DBF allografts.

Conclusions: DBF allograft anchors appear to be safe and effective for augmenting pedicle screws during revision surgeries in female elderly patients with reduced bone density.

Clinical relevance: Clinically, DBF reduced the rate of pedicle screw loosening in patients with reduced bone density. A significant reduction in screw loosening can decrease the need for revision surgeries, which are costly and carry additional risks. Enhanced bone integration from the DBF may promote better healing and long-term stability.

Level of evidence: 3:

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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
162
期刊介绍: The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.
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