皮质骨轨迹螺钉内固定术治疗腰椎融合术后邻近节段退变的临床疗效观察

Clinical observation of cortical bone track screw internal fixation in the treatment of adjacent segmental degeneration after lumbar fusion

目的探讨皮质骨轨迹(cortical bone trajectory,CBT)螺钉内固定治疗腰椎融合术后邻近节段退变(adjacent segment degeneration,ASD)的临床疗效。方法选取2016年6月至2019年11月西安交通大学附属红会医院收治的腰椎后路术后ASD病人60例作为研究对象,其中28例采用CBT螺钉内固定技术(CBT组),32例采用传统椎弓根螺钉(pedicle screw,PS)内固定技术(PS组)。比较两组病人的手术时间、术中出血量、住院时间、术前及术后第1天肌酸磷酸激酶(creatine phosphokinase,CPK)水平、术前及术后各时间点的腰痛和下肢疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)和日本骨科协会(Japanese Orthopaedic Association,JOA)评分,观察两组围手术期的手术相关并发症情况以及术后末次随访螺钉松动断裂情况。结果本组60例病人随访(12.68±2.91)个月(8~18个月)。CBT组手术时间、术中出血量、住院时间、术后1 d的CPK水平均低于PS组,差异具有统计学意义(P均<0.05)。CBT组术后1周的腰痛及下肢疼痛VAS评分低于PS组,两组比较,差异有统计学意义(t=-2.115,P=0.038);但末次随访时,两组间的VAS评分比较,差异无统计学意义(P>0.05)。两组病人术前、术后1周及末次随访时的ODI、JOA评分比较,差异均无统计学意义(P均>0.05)。CBT组术后有3例病人各有1枚螺钉穿破骨皮质,PS组有4例病人术后第1天出现中度贫血,两组病人术中均未出现硬膜囊破裂、脑脊液漏、神经损伤、伤口感染等并发症。两组病人术后末次随访X线片均未见螺钉松动断裂情况。结论CBT内固定技术与传统PS内固定技术相比,能达到同等的治疗效果,同时还具有术区暴露范围小、出血量少、手术时间短、住院时间短等优点,对治疗腰椎融合术后ASD具有一定的微创价值。

Objective To explore the clinical efficacy of cortical bone trajectory(CBT)screw fixation in the treatment of adjacent segment degeneration(ASD)after lumbar fusion.Methods Sixty patients with ASD treated in Honghui Hospital affiliated to Xi􀆳an Jiaotong University from June 2016 to November 2019 were selected.Among them,28 patients were treated with CBT internal fixation(CBT group)and 32 patients with traditional pedicle screw(PS)fixation(PS group).The operation time,intraoperative blood loss,hospital stay,the level of creatine phosphokinase(CPK)before and 1 day after operation,the visual analogue scale(VAS)score of low back pain and lower limb pain,Oswestry Disability Index(ODI)and Japan Orthopaedic Association(JOA)scores were compared between the two groups.Perioperative complications and screw loosening,fractures in the last follow⁃up were observed.Results Sixty patients were followed up for(12.68±2.91)months(8⁃18 months).The time of operation,the amount of blood loss during operation,the time of hospitalization and the level of CPK on the 1st day after operation in CBT group were lower than those in PS group,and the difference was statistically significant(all P<0.05).The VAS score in CBT group was lower than that in PS group 1 week after operation,and the difference was statistically significant(t=-2.115,P=0.038).But at the last follow⁃up,there was no significant difference between the two groups(P>0.05).There was no significant difference in ODI and JOA scores between the two groups before operation,1 week after operation and at the last follow⁃up(all P>0.05).In the CBT group,3 patients each had a screw piercing the broken bone cortex,and 4 patients in the PS group had moderate anemia on the first day after operation.there were no complications such as dural sac rupture,cerebrospinal fluid leakage,nerve injury and wound infection in the two groups.No screw loosening and fracture was found in the last follow⁃up X⁃ray films of the two groups.Conclusion Compared with the traditional PS fixation,CBT internal fixation can achieve the same therapeutic effect,and has the advantages of small exposure area,less bleeding,short operation time and short hospital stay.It has a certain minimally invasive value in the treatment of ASD.