요추부 유합술에서 골 시멘트 충진 척추경 유관나사와 보통 척추경 나사 사이의 내고정물 실패 비교 및 연관된 위험인자의 분석: 선행연구 = 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

국문 초록 (Abstract)

연구 계획: 후향적 선행연구목적: 보통 척추경 나사와 골 시멘트 충진 척추경 유관나사를 사용한 환자들의 내고정물 실패율을 비교하고 이에 영향을 미치는 위험요인들을 분석하였다.
선행 연구문헌의 요약: 이전의 연구에서 골다공증이 동반된 환자에서 골 시멘트 충진 척추경 유관나사는 뽑힘 강도를 향상시키는 것으로 알려져 있었다.
그러나 내고정물의 실패의 임상 위험 요소에 대해서는 아직 정립되어 있지 않다.
대상 및 방법: 2016년 1월부터 2018년 12월까지 동일한 술자에 의해 척추 골절 및 퇴행성 흉요추부 질환으로 시행된 척추경 나사를 이용한 유합술을 시행하였던 총 177명의 환자를 대상으로 후향적으로 연구가 이루어졌다. 이중 118명은 보통 척추경 나사를 사용하였으며 59명은 골 시멘트 충진 척추경유관나사를 이용하였다. 추시기간 중 단순 방사선 검사 및 전산화 단층 촬영 검사를 통해 척추경 나사의 이완, 이동 또는 뽑힘 등 내고정물 실패를 확인하였으며 그 위험인자를 분석하였다.
결과: 총 177명의 환자 중에서 21명의 환자(11.9%, 21/177)에게서 내고정물 실패가 발생하였다. 이 중 보통 척추경 나사군 118명 중 18명의 환자(15.3%, 18/118), 골 시멘트 충진 척추경 유관나사군 59명중 3명의 환자(5.1%, 3/59)에서 내고정물 실패가 발생하였으며 이 두 군의 차이는 통계적으로유의미하였다(p<0.05). 내고정물 실패 유무로 두 그룹을 카이제곱 검정을 시행하였을 때, 65세 이상의 고령, 골다공증, 자가면역질환(류마티스 관절염, 전신 홍반 루푸스 등), 만성 신장질환 및 스테로이드 사용(p<0.05)은 내고정물 실패군에서 통계적으로 유의미하게 높은 것으로 나타났다. 다중 로지스틱회귀분석에서는 65세 이상 고령(odds ratio 4.47, 95% CI 1.14-17.58, p=0.032), 골다공증(odds ratio 3.68, 95% CI 1.27-10.72, p=0.017), 자가면역질환(odd ratio 3.60, 95% CI 1.07-12.15, p=0.039) 및 만성 신장질환(odds ratio 4.68, 95% CI 1.05-20.81, p=0.043)이 내고정물 실패와 통계적으로 유의미하게 나타났다결론: 65세 이상, 골다공증, 자가면역질환 또는 만성 신장질환이 있는 흉요추부 유합술을 시행한 환자에서 내고정물 실패가 높게 나타났다. 따라서 이러한 위험인자를 갖는 환자들은 내고정물 실패를 줄이기 위하여 골 시멘트 충진 척추경 나사를 이용하는 것이 효과적인 방법이 될 수 있을 것으로 사료된다.
약칭 제목: 척추경 나사의 내고정물 실패 비교 및 위험인자의 분석

다국어 초록 (Multilingual Abstract)

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.
Results: 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.

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