应用皮质骨轨迹螺钉联合椎弓根螺钉内固定技术治疗老年骨质疏松腰椎退变性疾病的临床疗效

目的 观察在腰椎后路减压植骨内固定术治疗老年骨质疏松腰椎退变性疾病中应用皮质骨轨迹(CBT)螺钉联合椎弓根螺钉技术进行内固定操作的临床疗效.方法 选择2014年2月至2015年4月在第二军医大学长征医院经保守治疗无效的骨质疏松腰椎退变性疾病患者32例进行腰椎后路减压植骨内固定术治疗,其中20例采用单纯椎弓根螺钉内固定方式(A组),12例采用CBT螺钉联合椎弓根螺钉内固定(B组).观察两组患者术后恢复情况、手术时间、术中出血量和手术前后VAS评分、JOA评分等.结果 所有患者症状均得到改善,术后JOA评分较术前提高,VAS评分降低.两组的手术时间、出血量、JOA评分和VAS评分差异均无统计学意义(P＞0.05).A组中有2例患者术中一侧因骨质疏松明显,椎弓根螺钉置入后把持力不足并出现钉道切割导致置钉失败,仅行对侧固定,其余患者置钉顺利.B组患者手术置钉过程未出现螺钉把持力不佳、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.全部32例患者术后影像学随访未见螺钉松动、脱落、塌陷等,螺钉、连接棒、融合器均在位,位置佳.所有病例无不良事件产生.结论 应用CBT螺钉联合椎弓根螺钉技术进行腰椎内固定治疗老年骨质疏松腰椎退变性疾病具有肌肉和软组织损伤小、螺钉把持力强等优势,早期疗效满意.

Curative effect of cortical bone trajectory screw combined with pedicle screw in internal fixation for senile osteoporosis lumbar degenerative disease

Objective In the lumbar posterior decompression, bone graft and internal fixation to treat osteoporosis of lumbar degenerative disease in the application of cortical bone trajectory screw (CBT) in combination with pedicle screw technique for internal fixation of clinical curative effect of the operation. Methods In February 2014 to April 2015, choose the invalid conservative treatment of 32 patients with osteoporosis of lumbar degenerative disease of lumbar posterior decompression, bone graft and internal fixation to treat internal fixation by pedicle screw fixation methods 20 cases, application of cortical bone screw joint pedicle screw technique in 12 cases. Observing two groups of patients with operation time, intraoperative blood loss, and VAS scores before and after operation, JOA score and period, etc. Results all the symptoms of 32 cases were improved, postoperatie JOA and VAS scores were significantly improved, between the two groups in operative time, blood loss, JOA score and VAS score comparison difference has no statistical significance. 2 cases of A group occured one side pedicle screw placement failure, carries out A unilateral fixed. More patients successfully nailing. Group B patients nailing process does not appear screw holding force poor nailing failure, cortical bone screw fracture fracture, and so on and so forth. All of the patients did not appear caused by nailing vascular and nerve damage. Postoperative radiographic follow-up no screw loose, fall off, such as collapse, screw, connecting rod, fusion in office, position. All cases with no adverse events. Conclusion Application of cortical bone tracks screw joint pedicle screw technique for lumbar spinal internal fixation in the treatment of senile osteoporosis lumbar degenerative disease with a small muscle and soft tissue injuries, the advantages of the screw holding power, the early curative effect is satisfied.