皮质骨轨迹螺钉固定技术在单间隙腰椎结核治疗中的效果分析

Clinical efficacy of the fixation technique by using cortical bone trajectory screws for monosegment lumbar spinal tuberculosis

目的探讨一期前路病灶清除植骨融合、后路皮质骨轨迹螺钉联合传统椎弓根螺钉单节段内固定术治疗单间隙腰椎结核的临床效果。方法选择2015年1月至2016年1月中国人民解放军空军军医大学第一附属医院脊柱外科收治的42例单间隙腰椎结核患者。根据后路内固定方案不同（内固定方案综合考虑患者临床情况和患者意愿）分为两组，A组21例患者采用一期前路病灶清除植骨融合、后路皮质骨轨迹螺钉联合传统椎弓根螺钉单节段内固定术治疗；B组21例患者采用一期前路病灶清除植骨融合、后路传统椎弓根螺钉短节段内固定术治疗。分析两组患者Cobb角、血红细胞沉降率（ESR）、C反应蛋白（CRP）、神经功能（Frankel脊髓损伤分级）及视觉模拟评分（VAS）在手术前后及随访过程中的变化情况。结果42例患者随访时间为18～30个月，平均（24．1±4．5）个月。两组患者术后3个月的ESR、CRP、VAS评分：A组分别为（13．5±5．5）mm／1h、（4．7±2．0）mg／L、（1．9±0．8）分，B组分别为（12．9±4．9）mm／1h、（5．2±3．2）mg／L、（2．2±1．0）分，差异均无统计学意义（f值分别为0．32、-0．68、-1．02，P值分别为0．747、0．500、0．312）；末次随访时后凸Cobb角矫正度数及后凸Cobb角丢失度数：A组分别为（11．6±6．3）°、（1．7±1．2）°，B组分别为（9．9±5．9）°、（1．4±1．1）°，差异均无统计学意义（t值分别0．96、0．94，P值分别为0．343、0．355）。42例患者术后Frankel脊髓损伤分级：术前1例B级患者恢复至D级；术前5例C级患者，4例恢复至D级，1例恢复至E级；术前26例D级患者全部恢复至E级。结论对于单间隙感染的腰椎结核患者，应用皮质骨轨迹螺钉固定技术可以实现单节段病椎内置钉内固定，能够保留邻近正常的椎体，是一种治疗单节段腰椎结核有效的手术方法。

Objective To evaluate the clinical efficacy of one-stage anterior debridement, bone grafting fusion and posterior cortical bone trajectory （CBT） screw fixation in combination with traditional pedicle screw internal fixation in lumbar single-segment instumentation for the treatment of monosegment lumbar spinal tuberculosis. Methods From January 2015 to January 2016, 42 patients with monosegment lumbar spinal tuberculosis in the First Affiliated Hospital of the Air Force Military Medical University of PLA were included in this analysis. All patients were divided into two groups based on the posterior internal fixation technique that was applied according to patient＇s clinical situation and wish. Internal fixation was performed by CBT screws combined with traditional pedicle screws in 21 patients （A group） and by traditional pedicle screws in 21 patients （B group） after anterior debridement and bone grafting fusion. The Cobb angle, the Frankel grade, erythrocyte sedimentation rate （ESR）, C-reactive protein （CRP） and visual analogue score （VAS） value of all patients were analyzed before and after surgery and during the follow-up period. Results Forty-two patients were followed-up from 18 to 30 months, with an average follow-up time of （24. 1 ± 4. 5） months. Three months after surgery, the ESR, CPR and VAS were （13.5±5.5） ram/1 h, （4.7±2.0） mg/L and （1.9±0.8） in group A and （12.9±4. 9） ram/1 h, （5.2±3.2） mg/L and （2.2± 1.0） in group B, respectively. The differences were not statistically significant （t= 0.32, -0. 68 and -1.02; P= 0. 747, 0. 500 and 0. 312）. The average correction degree and correlation loss of Cobb angle were （11. 6±6.3）° and （1.7±1.2）° in group A and （9.9±5.9）° and （1.4±1.1）° in group B at the last follow-up, with no significant statistical differences （t = 0.96 and 0.94; P = 0. 343 and 0. 355）. As to postoperative neurological improvement, 1 case with Frankd grade B before operation recovered to grade D; of the 5 cases with grade C before operation, 4 cases recovered to grade D and 1 case recovered to grade E; of the 26 cases with grade D before surgery, all recovered to grade E. Conclusion For patients with monosegment lumbar spinal tuberculosis, CBT screw fixation technique can fix and fuse the diseased single-segment and retain normal movement of the adjacent spinal column. It is indicative to monosegment lumbar spinal tuberculosis.