皮质骨通道螺钉技术在腰椎退变性疾病中的临床应用

目的探讨经椎弓根皮质骨通道（CBT）螺钉内固定技术在腰椎退变性疾病中的临床疗效。 方法回顾性收集中国人民解放军联勤保障部队第九二〇医院2016年8月~2018年5月间收治的腰椎退变性疾病患者53例，均行经后路椎管减压椎间植骨融合内固定手术治疗，其中23例应用CBT螺钉技术，30例应用传统椎弓根螺钉技术，分别观察两组患者手术时间、术中出血量、VAS评分、JOA评分和改善率以及术后恢复情况、有无并发症等，综合评价临床疗效。 结果所有患者均获得随访，随访时间为3~18个月，平均（12±4）个月。手术置钉过程中均未出现螺钉把持力不足、峡部或椎弓根劈裂以及在置钉过程中引起的血管、神经损伤等情况。两组患者症状均得到不同程度改善，术后JOA评分CBT组：（23.7±2.3）分，传统组：（23.9±2.0）分]和VAS评分CBT组：（1.2±0.7）分，传统组：（1.3±0.8）分]均较术前降低JOA评分：CBT组：（9.1±2.7）分，传统组：（10.3±2.0）分；VAS评分：CBT组：（5.3±1.2）分，传统组：（5.4±1.2）分；]，差异均具有统计学意义（均P<0.05）两组间比较手术时间CBT组：单节段为（2.0±0.3）h，双节段为（2.8±0.4）h。传统组：单节段为（2.1±0.3）h，双节段为（3.0±0.2）h]、术后VAS评分（CBT组：（1.2±0.7）分，传统组：（1.3±0.8）分]和JOA评分（CBT组：（23.7±2.3）分，传统组：（23.9±2.0）分]无明显统计学差异，但CBT螺钉组的术中出血量（单节段：（297±48）ml，双节段：（367±41）ml]少于传统椎弓根螺钉组（单节段：（347±44）ml，双节段：（427±46）ml]（t=-3.209，t=-2.692，P<0.05）。术后影像学随访均未见螺钉松动、尾冒脱落、钉棒断裂、椎间隙高度丢失、椎间融合器位移等不良事件的发生。 结论应用CBT螺钉内固定技术治疗腰椎退变性疾病是一种手术创伤更小、术后恢复更快且安全可靠、固定有效的置钉方法。

Clinical application of cortical bone screw technique in elderly patients with lumbar degenerative diseases

ObjectiveTo investigate the clinical outcome of application of transpedicular cortical bone trajectory (CBT) screw fixation in lumbar degenerative diseases. MethodsA retrospective research based on the collection of 53 lumbar degenerative disease cases, who underwent posterior spinal canal decompression and interbody fusion since August 2016 to May 2018, in 920 hospital of the PLA Joint Logistic Unit. 23 cases were treated with CBT screw technique and 30 cases were treated with traditional pedicle screw technique. The operation time, intraoperative blood loss, VAS score, JOA score and improvement rate and postoperative functional restoration, clinical complications has been observed in the two groups for comprehensive evaluation of clinical efficacy. ResultsAll patients received an average of (12±4) months (3-18 months) follows up. During the screw placement process, no insufficient holding of screws, isthmus or pedicle cleft palate occurred, blood vessel and nerve damage caused by the screw placement process as well. The symptoms of the two groups showed various degree of improvement. Postoperative JOA scores (CBT group: 23.7±2.3, pedicle screw group: 23.9±2.0) and VAS scores (CBT group: 1.2±0.7, pedicle screw group: 1.3±0.8) were improved compared with preoperative (CBT group: 5.3±1.2, pedicle screw group: 5.4±1.2). The operation time was compared between the two groups (CBT group: single segment was 2.0±0.3 h, double segment was 2.8±0.4 h. pedicle screw group: single segment 2.1±0.3 h, double segment 3.0±0.2 h), postoperative VAS score (CBT group: 1.2±0.7, pedicle screw group: 1.3±0.8) and JOA scores (CBT group: 23.7±2.3 points, pedicle screw group: 23.9±2.0 points) had no statistically significant difference, but the intraoperative blood loss of the CBT screw group (single segment: 297±48 ml, double segment: 367±41 ml) was less than the pedicle screw group (single segment: 347±44 ml, double segment: 427±46 ml)(t=-3.209, t=-2.692, P<0.05). No postoperative adverse events such as loose screws, tail screw detachment, broken screws loss of intervertebral space, and intervertebral cage displacement have been observed. ConclusionCBT screw for the treatment of lumbar degenerative disease is a less trauma, faster postoperative recovery, safe and reliable screw placement method.