皮质骨通道螺钉在骨质疏松性腰椎退行性疾病后路融合内固定术中的应用

Application of cortical bone screws in posterior fusion and internal fixation for osteoporotic lumbar degenerative diseases

目的探讨皮质骨通道螺钉在骨质疏松性腰椎退行性疾病后路植骨融合内固定术中应用的临床效果。方法回顾性分析自2016-06—2017-09诊治的42例骨质疏松性腰椎退行性疾病,均行腰椎后路植骨融合内固定手术,观察组19例术中使用皮质骨通道螺钉,对照组23例术中使用常规椎弓根钉。比较2组手术时间、术中出血量,术后3个月及末次随访时疼痛VAS评分、JOA评分。结果 42例手术均顺利完成,置钉过程中未出现血管、神经损伤,未出现因螺钉把持力不足、钉道滑移、钉道破坏等导致的置钉失败情况。42例均获得随访,随访时间平均8(6~9)个月。随访过程中未出现螺钉松动、脱落、融合失败等并发症。观察组术中出血量少于对照组,差异有统计学意义(P <0.05);但2组手术时间、术后3个月及末次随访时疼痛VAS评分、JOA评分比较差异无统计学意义(P>0.05)。结论皮质骨通道螺钉在骨质疏松性腰椎退行性疾病后路植骨融合内固定术中应用不仅具有良好的安全性、可行性、有效性,而且与常规椎弓根钉内固定手术相比可减少手术创伤和术中出血量。

Objective To explore the clinical effect of cortical bone screws in posterior bone graft fusion and internal fixation for osteoporotic lumbar degenerative diseases. Methods A retrospective analysis of 42 cases of osteoporotic lumbar degenerative diseases diagnosed and treated from June 2016 to September 2017 was performed after posterior lumbar fusion and internal fixation. The cortical bone screws were used in the observation group of 19 cases while the conventional pedicle screws were used in the control group of 23 patients. The operation time, the intraoperative blood loss, the pain VAS score and JOA score of the postoperative 3 months and the last follow-up were compared between the two groups. Results All operations on the 42 cases were successfully completed. There was no blood vessel or nerve damage during the nail placement. There was no failure of the nail caused by insufficient screw holding force, nail path slip and nail path damage. All 42 cases were followed up for 6-9 months, average 8 months. There were no complications such as loosening of screws, shedding, and failure of fusion during follow-up. The intraoperative blood loss in the observation group was lower than that in the control group, and the difference was statistically significant （P 〈0.05）. However, there was no significant difference in the operation time, the pain VAS score and JOA score at 3 months after operation and at the last follow-up between the two groups （P 〉0.05）. Conclusion The application of cortical bone screws in posterior bone graft fusion and internal fixation for osteoporotic lumbar degenerative diseases is safe, feasible and effective, with less surgical trauma and intraoperative blood loss compared with conventional pedicle screw fixation.