皮质轨迹螺钉与椎弓根螺钉固定治疗腰椎退行性疾病合并骨质疏松患者的疗效  

Efficacy of cortical bone trajectory versus pedicle screw fixation in treatment of patients with lumbar degenerative disease combined with osteoporosis

作　　者：鲍小明 张小平 郭卫东 董鑫 任坤 赵海恩 廖博 Bao Xiaoming;Zhang Xiaoping;Guo Weidong;Dong Xin;Ren Kun;Zhao Haien;Liao Bo(Department of Orthopaedics,the Second Affiliated Hospital of the Air Force Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学第二附属医院骨科,西安710038

出　　处：《中华临床医师杂志(电子版)》2024年第11期980-985,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金：国家自然科学基金(82174166);陕西省自然科学基础研究计划资助项目(2023-JC-JQ-70);西安市科技计划项目医学研究重点项目(24YXYJ0007);唐都医学院学科助推计划交叉融合项目(2024JCRH004);国家自称科学基金联合基金项目(U2420115)

摘　　要：目的对比分析皮质骨轨迹螺钉(CBT)与椎弓根螺钉(PS)固定的经椎间孔腰椎椎体间融合术(TLIF)治疗腰椎退行性病变合并骨质疏松的临床及影像学及并发症。方法回顾性分析2019年1月~2022年3月于空军军医大学第二附属医院治疗单节段腰椎退行性病变合并骨质疏松患者的临床资料,依据患者固定方式将患者随机分为CBT固定组(n=48)与PS固定组(n=53),CBT组(66.20±8.45)岁,男性17例,女性31例,PS组年龄(66.83±7.41)岁,男性18例,女性35例,平均随访时间(12.20±3.47)月。比较2组患者VAS评分、Oswestry功能障碍指数(ODI)、手术时间、术中出血量、术后引流量、住院天数、影像学结果及并发症。结果2组患者均顺利完成手术;CBT组手术时间、术中出血量、切口长度、术后引流量均显著优于PS组(P<0.05),2组住院时间的差异均无统计学意义(P>0.05),腰痛及腿疼VAS评分和ODI指数均显著降低(P<0.05)。术后3个月时CBT组ODI指数低于PS组(P<0.05),末次随访时腰腿痛VAS评分和ODI指数差异无统计学意义(P>0.05)。末次随访时椎间融合率CBT组为45/48(93.75%),传统组为48/53(90.57%),2组间差异无统计学意义(P>0.05),螺钉松动率CBT组优于PS组(P<0.05)。结论腰椎退变性疾病合并骨质疏松行TLIF融合术CBT固定较PS固定短期疗效更佳,CBT组的腰椎稳定性显著更好,在骨质疏松患者TLIF中CBT螺钉固定是一种合理的固定。Objective To make a comparative analysis of the efficacy and complications of transforaminal lumbar interbody fusion(TLIF)with cortical bone trajectory(CBT)fixation versus pedicle screw(PS)fixation in the treatment of lumbar degenerative disease combined with osteoporosis.Methods Clinical data of patients with single-segment lumbar degenerative disease combined with osteoporosis treated in the Second Affiliated Hospital of the Air Force Medical University from January 2019 to March 2022 were retrospectively analyzed,and the patients were randomly divided into either a CBT fixation group(n=48)or a PS fixation group(n=53)based on the fixation method used.Patients in the CBT group had a mean age of(66.20±8.45)years old,with 37 male and 32 female cases,while those in the PS group had a mean age of(66.83±7.41)years old,with 36 males and 31 females.The mean followup time was(12.20±3.47)months.Visual analogue scale(VAS)score,Oswestry dysfunction index(ODI),operative time,intraoperative bleeding,postoperative drainage,hospitalization days,imaging findings,and complications were compared between the two groups of patients.Results Surgery was successfully completed in both groups.Operation time,intraoperative bleeding,incision length,and postoperative drainage were significantly better in the CBT group than in the PS group(P<0.05),but the difference in hospitalization time between the two groups was not statistically significant(P>0.05).Low back pain and leg pain VAS scores and ODI decreased significantly in both groups after surgery(P<0.05).ODI was lower in the CBT group than in the PS group at 3 months postoperatively(P<0.05),though the difference in low back and leg pain VAS scores and ODI at the final follow-up was not statistically significant(P>0.05).The proportion of patients with interbody fusion at the last follow-up was 45/48(93.75%)in the CBT group and 49/53(90.57%)in the PS group,and the difference between the two groups was not statistically significant(P>0.05).The screw loosening rate was better in the CBT

关 键 词：皮质骨轨迹螺钉 椎弓根螺钉 腰椎融合术 骨质疏松 

分 类 号：R687.3[医药卫生—骨科学]