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

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

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。

Objective To evaluate the curative effect of cortical bone trajectory（CBT）screw in combination with pedicle screw in lumbar posterior decompression,bone graft and internal fixation for the treatment of osteoporosis lumbar degenerative diseases.Methods From February 2014 to April 2015,32 patients with osteoporosis lumbar degenerative diseases underwent posterior decompression,bone graft and internal fixation after invalid conservative treatment.Internal fixation was performed by pedicle screws in 20patients（A group）and by CBT screws combined with pedicle screws in 12patients（B group）.The recovery,operation time,intraoperative blood loss and VAS scores before and after operation,and JOA score were recorded in the two groups.Results The symptoms were improved in all the 32 patients.After surgery,JOA scores were significantly increased and VAS scores were significantly decreased.There were no significant differences in terms of operation time,blood loss,JOA score or VAS score between the two groups（P〉0.05）.In A group,one side pedicle screw placement failed due to osteoporosis in 2cases and unilateral fixation was subsequently carried out.No poor screw holding force,nailing failure,or fracture breakage appeared in B group.No vascular or nerve damage caused by nailing was found in B group.The postoperative radiographic follow-up showed no screw loosening,fall-off or collapse;and the screw,connector,and fusion cage were all at the right position.There were no any adverse events in the two groups.Conclusion CBT screws in combination with pedicle screws in lumbar internal fixation have the advantage of less muscle and soft tissue injuries,strong screw holding force,and satisfied early curative effect in treating senile osteoporosis lumbar degenerative diseases.