皮质骨轨迹螺钉与椎弓根螺钉内固定治疗老年腰椎结核的病例对照研究

Case-control study on cortical bone trajectory screw and pedicle screw internal fixation for the treatment of senile patients with lumbar tuberculosis

目的:比较采用皮质骨轨迹(cortical bone trajectory,CBT)螺钉与椎弓根螺钉(pedicle screw,PS)内固定治疗老年腰椎结核的临床疗效。方法:自2014年1月至2017年1月,将42例老年腰椎结核患者分为CBT组和PS组,每组21例。CBT组男12例,女9例;年龄64~81(72.52±9.25)岁;骨密度T值(-2.69±0.17)g/cm3;行后路皮质骨轨迹螺钉内固定前路病灶清除植骨融合术。PS组男11例,女10例;年龄63~85(71.42±9.81)岁;骨密度T值(-2.70±0.21)g/cm3;行后路椎弓根螺钉固定前路病灶清除植骨融合术。比较两组患者后路切口长度、术中出血量、手术时间、植骨融合时间及并发症情况,比较手术前后血沉(erythrocyte sedimentation rate,ESR),C-反应蛋白(C-reactive protein,CRP),节段后凸Cobb角变化情况;采用VAS评分评价疼痛缓解程度;JOA评分评价临床疗效。结果:42例患者获得随访,时间12~21(15.00±3.57)个月。所有患者未见腰椎结核复发及螺钉松动情况。两组患者后路切口长度、手术出血量、手术时间比较差异有统计学意义(P<0.05)。两组患者术后2周及1、6个月,ESR、CRP与术前相比均有显著改善(P<0.05),但两组间比较差异无统计学意义(P>0.05)。两组并发症及植骨融合时间比较差异无统计学意义(P>0.05)。两组患者术后1周节段后凸Cobb角比较差异无统计学意义(P>0.05),而术后12个月Cobb角比较差异有统计学意义(P<0.05)。两组术前及术后3个月VAS评分比较差异无统计学意义(P>0.05),但两组术后3个月较术前明显改善(P<0.05)。两组术前、术后3和12个月JOA评分比较差异无统计学意义,而两组术后3、12个月JOA评分与术前比较差异有统计学意义(P<0.05)。结论:皮质骨轨迹螺钉内固定和椎弓根螺钉内固定治疗老年腰椎结核均取得满意疗效,椎弓根螺钉内固定固定范围较长,创伤大,而皮质骨轨迹螺钉内固定仅需固定病变相邻节段减少了固定范围,具有创伤小、螺钉把持力强的优点。

Objective:To compare clinical effect of cortical bone trajectory(CBT)screw and pedicle screw(PS)internal fixation in treating senile patients with lumbar tuberculosis.Methods:From January 2014 to January 2017,42 senile patients with lumbar tuberculosis were divided into CBT group and PS group,21 patients in each group.In CBT group,there were 12 males and 9 females,aged from 64 to 81 years old with an average of(72.52±9.25)years old,T value of bone mineral density was(-2.69±0.17)g/cm3,posterior CBT screw internal fixation and anterior debridement,interbody fusion with bone grafting was performed.In PS group,there were 11 males and 10 females,aged from 63 to 85 years old with an average of(71.42±9.81)years old,T value of bone mineral density was(-2.70±0.21)g/cm3,PS internal fixation and anterior debridement,interbody fusion with bone grafting were performed.Length of posterior incision,intraoperative bleeding volume,operation time,time of bone graft fusion and complications between two groups were compared.Level of erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),segment kyphotic Cobb angle before and after operation were compared,VAS score was used to evaluate pain releasing,JOA score was applied to evaluate clinical effect.Results:All patients were followed up from 12 to 21 months with an average of(15.00±3.57)months.No reoccurrence of lumbar tuberculosis and screw loosing occurred.There were statistical difference in length of incision,intraoperative bleeding volume,operation time between two groups(P<0.05).Level of ESR and CRP between two groups at 2 weeks,1 month and 6 months after operation were improved after operation,while there were no differences between two groups(P>0.05).There were no statistical differences in complications,time of bone graft fusion and segment kyphotic Cobb angle at 1 week after operation between two groups(P>0.05).There was difference in Cobb angle at 12 months after operation(P<0.05).For VAS score,there were no difference between two groups before operation and 3 months after operation(P>0.05),but VAS score at 3 months after operation were improved after operation between two groups(P<0.05).For JOA score,there were no difference between two groups before operation,3 and 12 months after operation,and JOA score at 3 and 12 months after operation were improved than that of before operation between two groups(P<0.05).Conclusion:Both of CBT screw internal fixation and PS screw internal fixation could achieve satisfying results for the treatment of elderly patients with lumbar tuberculosis.PS internal fixation has a long fixation but great trauma.However,CBT screw internal fixation only needs to fix adjacent segments of the lesion to reduce the fixation range,which has advantages of less trauma and strong screw holding force.