皮质骨通道螺钉结合改良腰椎后路椎间融合术治疗腰椎退变性疾病的临床疗效

目的探讨皮质骨通道(cortical bone trajectory,CBT)螺钉结合改良腰椎后路椎间融合术(posterior lumbar interbody fusion,PLIF)治疗腰椎退变性疾病的临床疗效。方法回顾分析我院2016年1月至2018年1月的72例腰椎退变性疾病病人的临床资料,按手术方式分为椎弓根螺钉PLIF组(29例)、CBT螺钉PLIF组(24例)和改良CBT螺钉PLIF组(19例)。分析三组的手术时间、术中出血量、术后引流量、术后卧床及住院时间、术后血清肌酸激酶(creatine kinase,CK)浓度及围手术期并发症;比较各组术后12个月的疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)及融合率。结果改良CBT螺钉PLIF组的手术时间、术中出血量、术后引流量、术后住院时间、术后12个月的ODI均显著少于其他两组,差异均有统计学意义(P均<0.05);椎弓根螺钉PLIF组的CK值和术后卧床时间均显著高于其他两组,差异均有统计学意义(P均<0.05)。三组的并发症发生率、术后12个月的VAS评分和融合率比较,差异均无统计学意义(P均>0.05)。结论CBT螺钉固定结合改良PLIF术式治疗腰椎退变性疾病手术时间短、术中出血量少、创伤小、术后恢复快,临床疗效满意。

Application of modified posterior lumbar interbody fusion with cortical bone trajectory screw in the treatment of lumbar degenerative disease

Objective To explore the clinical effect of modified posterior lumbar interbody fusion (PLIF) with cortical bone trajectory (CBT) screw fixation technique in the treatment of lumbar degenerative disease. Methods Seventy-two patients with lumbar degenerative disease treated with single segment fusion operation from January 2016 to January 2018 were retrospectively analyzed. According to the operation methods, the patients were divided into pedicle screw PLIF group (29 cases), CBT screw PLIF group (24 cases) and modified CBT screw PLIF group (19 cases). The operation time, intraoperative blood loss, postoperative drainage, postoperative bed and hospital stay, postoperative serum creatine kinase (CK) concentration and perioperative complications were analyzed in the three groups, and the visual analogue scale (VAS) score, Oswestry disability index (ODI) and fusion rate of the patients at 12th month after operation in each group were compared. Results The operation time, intraoperative blood loss, postoperative drainage volume, postoperative hospital stay, and 12-month ODI in the modified CBT screw PLIF group were significantly reduced as compared with those in the remaining two groups, and the differences were statistically significant (all P<0.05). The CK value and postoperative bed rest time in the pedicle screw PLIF group were significantly increased as compared with those in the rest two groups, and the differences were statistically significant (all P<0.05). There was no statistically significant difference in the incidence of complications, VAS score and fusion rate at 12th month after operation among the three groups (all P>0.05). Conclusion CBT screw fixation combined with modified PLIF procedure for the treatment of lumbar degenerative diseases has shorter operation time, less intraoperative blood loss, less trauma, quicker postoperative recovery, and more satisfactory clinical efficacy.