椎弓根皮质骨轨迹螺钉固定技术在腰椎融合术后邻近节段退变疾病中的应用

Clinical application of cortical bone trajectory screw fixation technique for patients with adjacent segment disease after lumbar spinal fusion

目的分析应用椎弓根皮质骨轨迹(cortical bone trajectory,CBT)螺钉固定技术在腰椎融合术后邻近节段退变疾病(adjacent segment disease,ASDis)中的临床疗效。方法回顾性分析2015年1月-2019年1月期间,应用CBT螺钉固定技术治疗的ASDis患者15例,其中,男6例,女9例;平均年龄为(62.7±10.2)岁(56-78岁)。记录手术时间、手术出血量、切口长度、腰腿疼痛评分(VAS)及腰椎功能评分(ODI)改善情况,并观察术后1年的植骨融合率。结果15例患者手术过程顺利,手术时间平均(105.7±22.4)min(80-140min);手术出血量平均(145.6±80.6)ml(90-400ml);手术切口长度(5.8±2.9)cm(5-9cm),单纯CBT螺钉固定8例,混合式固定7例。术后随访患者12-24个月(平均16.6个月)。术前腰痛VAS评分(6.6±2.4)分,末次随访为(2.1±1.2)分;术前腿痛VAS评分(7.2±2.7)分至末次随访的(1.8±1.0)分;ODI评分由术前(36.5±2.6)分至末次随访(4.1±2.0)分,各组手术前后指标比较差异均有统计学意义(P<0.05)。末次随访椎间植骨均已融合,融合率100%。结论CBT螺钉固定技术治疗腰椎融合术后ASDis能取得满意的临床疗效,是ASDis翻修治疗可行的手术方式。

Objective To analyze the clinical efficacy of cortical bone trajectory screw(CBT)fixation technique to treat the adjacent segment disease after lumbar spinal fusion.Methods A retrospective analysis was made on the clinical data of 15 patients(6 males and 9 females;56-78 years old,average 62.7±10.2 years)with adjacent segment disease after lumbar spinal fusion undergoing posterior cortical bone trajectory screw fixation from Jan 2015 to Jan 2019.The operation time,blood loss,skin incision length,improvement of patient’s lumbar and leg pain(VAS),lumbar function(ODI),and bone graft fusion rate of a year after surgery were evaluated.Results All operations were successfully completed in 15 patients.The operative time was 105.7±22.4min(80-140min),intraoperative blood loss was 145.6±80.6ml(90-400ml)and skin incision length was 5.8±2.9cm(5-9cm).There were 8 cases with CBT screw fixation alone and 7 cases with mixed fixation.All patients were followed up for from 12 to 24 months(averaging 16.6 months).The VAS of patient’s lumbar and leg pain was improved from 6.6±2.4 and 7.2±2.7 preoperation to 2.1±1.2 and 1.8±1.0 at the final follow-up postoperation.The ODI of lumbar function was improved from 36.5±2.6 preoperation to 4.1±2.0 at the final follow-up postoperation.There were significant differences on the VAS and ODI between preoperative and postoperative,respectively(P<0.05).All the intervertebral bone grafts were fused,and the fusion rate was 100%at the final follow-up.Conclusion CBT screw fixation technique for the treatment of ASDis after lumbar fusion can achieve satisfactory clinical effect and it might be good achoice of revision ASDis.