INFLUENCE OF BONE-MINERAL DENSITY ON THE FIXATION OF THORACOLUMBAR IMPLANTS - A COMPARATIVE-STUDY OF TRANSPEDICULAR SCREWS, LAMINAR HOOKS, AND SPINOUS PROCESS WIRES

被引：200

作者：

COE, JD

WARDEN, KE

HERZIG, MA

MCAFEE, PC

机构：

[1] Orthopaedic Surgery Service, Brooke Army Medical Center, Fort Sam Houston, TX

[2] Division of Spinal Reconstructive Surgery, Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD

来源：

SPINE | 1990年 / 15卷 / 09期

关键词：

Bone mineral density; Laminar hooks; Osteoporosis; Pedicle screws; Spinal implants; Spinous process wires; Transpedicular screws;

D O I：

10.1097/00007632-199009000-00012

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Posteriorly directed load to failure testing of four different types of spinal implants was performed in individual T5 to S1 vertebra harvested from seven fresh-frozen human cadaveric spines. The implants tested were: 1) Drummond spinous process wires, 2) Harrington laminar hooks, 3) Cotrel-Dubousset transpedicular screws, and 4) Steffee VSP transpedicular screws. The ultimate failure of each implant was compared with the bone mineral density of each vertebra to determine which implants, if any, were particularly advantageous in osteoporotic vertebrae. Before biomechanical testing, the spines were analyzed in vitro by dual photon absorptiometry to determine the bone mineral densities (gm/cm2) of each vertebra. The mean tensile loads to failure for each of the implants tested were as follows: Cotrel-Dubousset transpedicular screws: 345 Newtons; spinous process wire/ button: 382 Newtons; Steffee transpedicular screws: 430 Newtons; and laminar hooks: 646 Newtons. The difference between the loads to failure for laminar hooks and the other implants was significant (P < 0.05) using oneway analysis of variance. The overall correlation coefficient for bone mineral density with ultimate load to failure was 0.30 (P < 0.001). The correlation coefficients were 0.47 (P < 0.001) for spinous process wires alone; 0.096 (not significant) for laminar hooks alone; 0.37 (P < 0.001) for Cotrel-Dubousset pedicle screws; and 0.48 (P < 0.001) for Steffee pedicle screws. Of the four different implants tested, laminar hooks were most resistant to failure from posteriorly directed forces. In contrast to spinous process wires and transpedicular screws, loads to failure for laminar hooks did not correlate with bone mineral density. The increased resistance to failure from posteriorly directed forces and independence from variations in bone mineral density may indicate that laminar hooks are superior to spinous process wires and pedicle screws for spinal fixation in patients with decreased bone mineral density due to osteoporosis, osteomalacia, or other forms of metabolic bone disease. © Lippincott-Raven Publishers.

引用

页码：902 / 907

页数：6

共 25 条

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