皮质骨轨道螺钉与常规椎弓根螺钉治疗合并骨质疏松的腰椎退行性疾病的对比研究  

Comparison of cortical bone trajectory screws and traditional trajectory screws in treatment of lumber degenerative patients with osteoporosis:a retrospective analysis

作　　者：刘正沛 寇红伟[1] 尚国伟[1] 姬彦辉 陈向荣 孙新志[1] 包德明 程田[1] 郭俊杰[1] 尚春风 燕淼恒 耿志华 朱迪[1] 赵哲[1] 王义生[1] 刘宏建[1] Liu Zhengpei;Kou Hongwei;Shang Guowei;Ji Yanhui;Chen Xiangrong;Sun Xinzhi;Bao Deming;Cheng Tian;Guo Junjie;Shang Chunfeng;Yan Miaoheng;Geng Zhihua;Zhu Di;Zhao Zhe;Wang Yisheng;Liu Hongjian(Department of Orthopaedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院骨科,郑州450052

出　　处：《中华解剖与临床杂志》2020年第3期278-284,共7页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨皮质骨轨道(CBT)螺钉技术与传统轨道(TT)椎弓根螺钉技术治疗伴有骨质疏松症但不合并椎体Ⅰ度以上滑脱或脊柱侧凸的单节段腰椎退行性疾病患者的临床疗效。方法回顾性分析2017年2月—2019年2月在郑州大学第一附属医院接受L3/4或L4/5单节段腰椎融合术并且伴有骨量减少或骨质疏松症同时不合并椎体Ⅰ度以上滑脱或脊柱侧凸的52例女性患者资料,年龄40~71岁,其中22例接受了CBT螺钉手术(CBT组)、30例接受了TT螺钉手术(TT组)。对比观察两组患者手术时间、术中出血量、手术切口长度和手术并发症;术后第5天经摄腰椎X线片和CT扫描观察融合器、内固定位置,以及近端关节突关节侵扰(FJV)发生率;术后3、6、12、24个月复查腰椎正侧位X线片,评估植骨融合和内固定等情况;对比两组患者手术前及末次随访的Oswewtry功能障碍指数(ODI)和疼痛视觉模拟评分(VAS)。结果CBT组与TT组手术时间分别为(125.7±16.0)min和(123.8±18.3)min,差异无统计学意义(t=0.389,P>0.05);术中出血量CBT组[(74±39.8)mL]比TT组[(129±45.3)mL]少,手术切口长度CBT组[(5.7±0.6)cm]比TT组短[(8.4±0.92)cm],差异均有统计学意义(t=4.548、12.004,P值均<0.05)。术中TT组有1例患者L42枚椎弓根螺钉出现固定强度不佳,遂采用骨水泥强化椎弓根螺钉,其余患者手术置钉过程均未出现置钉失败、皮质骨钉道骨折断裂等情况;所有患者均未出现置钉引起的血管、神经损伤。术后第5天经摄腰椎X线片和CT扫描观察融合器、内固定位置良好;CBT组有3例患者共4个近端关节突关节发生FJV(4/44,9.09%),而TT组中有22例患者共35个近端关节突关节发生FJV(35/60,58.33%),两组比较差异有统计学意义(χ^2=26.263,P<0.01)。术后随访5~24个月,两组患者症状均得到改善,与术前相比末次随访的ODI及VAS均降低,差异均有统计学意义(t=16.549、18.490,P<0.01);而手术前后ODI和VAS组间比较差Objective To investigate and compare the clinical outcome of cortical bone trajectory(CBT)screws and traditional trajectory(TT)screws in treatment of single segment lumber degenerative patients with osteoporosis but without scoliosis or spondylolisthesis above degree I.Methods From February 2017 to February 2019,a retrospective analysis was made of 52 female patients who underwent L3/4 or L4/5 lumbar fusion with CBT screws or TT screws,aged 40-71 years,and accompanied by osteopenia or osteoporosis and without spondylolisthesis or scoliosis above grade I.Among them,22 received CBT screw operation(CBT group)and 30 received TT screw operation(TT group).The operation time,intraoperative blood loss,surgical incision length and surgical complications were compared between the two groups.On the 5th day after operation,lumbar spine X-rays and CT scans were used to observe the fusion device,internal fixation position,and the incidence of proximal articular process joint infiltration(FJV).At 3,6,12,and 24 months after surgery,the lumbar spine X-ray film was reviewed to evaluate bone graft fusion and internal fixation.The Oswestry dysfunction index(ODI)and pain visual analogue score(VAS)were compared between the two groups of patients before surgery and the last follow-up.Results The operative time of CBT group and TT group was(125.7±16.0)min and(123.8±18.3)min respectively,the difference was not statistically significant(t=0.389,P>0.05);the intraoperative blood loss of CBT group was(74±39.8)mL,less than that of TT group(129±45.3)mL,and the incision length of CBT group was(5.7±0.60)cm,shorter than that of TT group(8.4±0.92)cm,the difference was statistically significant(t=4.548,12.004,all P values<0.05).Because of the poor fixation strength,one case in TT group ended up in using bone cement augmented pedicle screw in L4.The remaining patients did not experience nail placement failure or cortical bone fracture fractures during surgical nail placement.No vascular or nerve damage was found in any patient.X-ray and CT sca

关 键 词：脊柱疾病 脊柱融合术 皮质骨轨道螺钉 骨质疏松症 腰椎退行性疾病 

分 类 号：R687.3[医药卫生—骨科学] R580[医药卫生—外科学]