| Objective:A retrospective analysis was conducted on patients with lumbar degenerative diseases who underwent bone cement screw internal fixation.The study aimed to explore the correlation between CT values before screw fixation and bone cement injection,and to identify the critical range of CT values for bone cement enhanced fixation of lumbar vertebrae 3～lumbar 5.Additionally,the study examined the difference of intraoperative screw torque in patients undergoing lumbar internal fixation fusion due to degenerative diseases of the lumbar spine.The strength of nail setting feel was also analyzed,and screw stability was evaluated relatively quantitatively.The study also observed the improvement of symptoms and screw loosening in patients with osteoporosis who underwent lumbar internal fixation and fusion after general anti-osteoporosis treatment and oral Gushukang capsule.Methods:Study 1:The study enrolled 89 patients with lumbar degenerative disease who underwent lumbar spinal internal fixation fusion surgery at Dongzhimen Hospital of Beijing University of Chinese Medicine from July 2016 to June 2019.Patients were divided into two groups based on whether bone cement was injected into the vertebral body during surgery:the bone cement group(29 patients)and the non-bone cement group(60 patients).The study analyzed the internal correlation between CT values before screw fixation and whether or not bone cement was injected,and preliminarily screened out the critical range of CT values for bone cement enhanced fixation of lumbar vertebrae 3～lumbar 5.Study 2:The study enrolled 34 patients with lumbar degenerative disease who underwent lumbar spinal internal fixation fusion surgery at Dongzhimen Hospital of Beijing University of Chinese Medicine from January to December 2020.A total of 188 screws were included in the study.The screws were divided into four groups based on the resistance level of the nail setting feel of the operating surgeon:small resistance group(17 screws),moderate resistance group(93 screws),high resistance group(66 screws),and difficult to screw group(12 screws).The study used a digital torque measurement device to measure the torque during screw insertion and analyzed its correlation with the strength of nail setting feel in order to evaluate screw stability relatively quantitatively.Study 3:The study included 35 patients who underwent lumbar spinal internal fixation fusion surgery for lumbar degenerative disease at Dongzhimen Hospital of Beijing University of Chinese Medicine from January to December 2021.The patients were divided into a control group and an observation group using a random number table method.Patients in the control group received oral calcium carbonate D3 tablets at a dose of 1 tablet once daily for 12 weeks after surgery.Patients in the observation group received Gushukang capsules in addition to the treatment given to the control group,with a dose of 4 capsules twice daily for 12 weeks.The study recorded patients’ VAS,JOA,and ODI scores,as well as screw loosening after surgery,at multiple time points including preoperatively,2 weeks,3 months,6 months,and 12 months postoperatively,to evaluate the effectiveness of the treatment.Results:Study 1:CT values of L3,L4 and L5 vertebra in bone cement group were 61.5±3.9 HU,66.0±4.0 HU and 75.7±4.0 HU,respectively.The CT values of L3,L4 and L5 vertebra in the non-cement group were 96.9±3.0 HU,102.6±3.2 HU and 116.4±3.7 HU,respectively,and the differences between the two groups were statistically significant(P<0.001).In the bone cement group,the vertebral body CT values showed non-normal distribution,and the median CT values of L3,L4 and L5 vertebrae,namely 63 HU,70 HU and 78 HU,were used as the threshold to predict the vertebrae requiring bone cement reinforcement.Logistic regression results of vertebral CT value and whether the bone cement screw was filled with bone cement showed that:L3 vertebral body:OR=0.862,95%CI(0.805,0.923);L4 vertebral body:OR=0.906,95%CI(0.869,0.945);L5 vertebral body:OR=0.906,95%CI(0.867,0.947),all showed significant negative correlation.The ROC relationship between vertebral CT value and pedicle screw cement reinforcement was AUC>0.80(P<0.05),vertebral CT value has a good predictive value for bone cement reinforcement.Study 2:The feel resistance group(Group A)had a feel score of 2.6±0.1,and the average torque of screws was 1.23±0.04 N·m.The general group of nail feel resistance(Group B)had a feel score of 4.8±0.1,and the average torque of screws was 1.72±0.02 N·m.The feel score of the group with large nail resistance(group C)was 6.7±0.1,and the average torque of screws was 2.35±0.03 N·m.In the Laborious Group(Group D),the feel score was 8.4±0.1,and the average screw torque was 3.87±0.25 N·m.The difference in tactile score between group A and group B,group A and group C,group A and group D,group B and group C,and group B and group D was statistically significant(P≤0.001);the difference in torque value between group A and group B,group A and group C,group B and group C,and group B and group D was statistically significant(P≤0.05);there was no significant difference in hand score between group C and group D(P=0.129).There was no significant difference in torque between group C and group D(P=0.112).There was a significant correlation between the nail setting feel and the screw torque value(P<0.001),and the correlation coefficient was 0.961>0.8,which showed a significant strong positive correlation.Study 3:There were no significant differences in VAS scores between the observation group and the control group 1 day before surgery,3 months,6 months and 12 months after surgery,but there were significant differences in VAS scores between the two groups 2 weeks after surgery(P<0.05),observation group was lower than control group;There was no significant difference in lumbar JOA scores between the observation group and the control group 1 day before surgery,6 months and 12 months after surgery,but there were significant differences in lumbar JOA scores between the two groups 2 weeks and 3 months after surgery(P<0.05),observation group was higher than control group;There was no significant difference in the lumbar ODI score between the observation group and the control group 1 day before surgery,2 weeks after surgery,6 months after surgery,12 months after surgery,but there was significant difference in the lumbar ODI score between the two groups 3 months after surgery(P<0.05),observation group was lower than control group;There was no significant difference in screw loosening between the observation group and the control group before and after 2 weeks,3 months,6 months and 12 months.Conclusions:(1)The CT value of the lumbar vertebra can be used to predict whether cement reinforcement is required for the pedicle screw.The lower the CT value,the more cement reinforcement is recommended.When the CT value of L3 vertebra is below 70 HU,L4 vertebra is below 95 HU,and L5 vertebra is below 99 HU,bone cement reinforcement is recommended to enhance screw stability.(2)The torque of pedicle screw placement was positively correlated with the feel of screws,that is,the higher the torque value,the worse the feeling of screws.(3)Hand feel score and pedicle screw torque value can assist the surgeon to judge the stability of the screw.When the hand feel score is less than 3 and the torque value is less than 1.3N·m,the screw is more likely to loose after surgery,and it is recommended to strengthen fixation with bone cement.(4)After lumbar transpedicle internal fixation,general anti-osteoporosis therapy combined with oral Kusukang has a good effect in relieving pain and restoring dysfunction within 3 months after surgery,and the effect of preventing screw loosening still needs to be verified by medium-and long-term follow-up. |
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