皮质骨螺钉和骨水泥钉道强化椎弓根螺钉固定治疗骨质疏松伴腰椎退变性疾病的对比研究

A comparative study of cortical bone screws and cement augmented pedicle screw instrumentation for osteoporosis with lumbar degenerative disease

目的比较皮质骨螺钉(CBT)和骨水泥钉道强化椎弓根螺钉(PMMA)固定治疗骨质疏松伴腰椎退变性疾病的效果。方法选取我院2019年1月至2020年9月接受后路椎间融合内固定术的骨质疏松伴腰椎退变性疾病患者80例为研究对象,随机分为观察组和对照组,每组各40例。对照组患者采用PMMA固定技术治疗,观察组患者给予CBT固定技术治疗。记录手术时间和术中出血量,运用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数评分(ODI)评估患者症状和疼痛的改善情况,随访1年,统计两组患者的植骨融合率和神经损伤、伤口感染、螺钉松动等术后并发症情况。结果观察组的手术时间短于对照组,出血量少于对照组,差异有统计学意义(P<0.05)。治疗前,两组的VAS评分和ODI评分相比,差异无统计学意义(P>0.05);治疗后,两组的VAS评分和ODI评分低于治疗前,差异有统计学意义(P<0.05),且两组的VAS评分和ODI评分相比,差异无统计学意义(P>0.05)。两组患者的植骨融合率和术后并发症发生率比较,差异无统计学意义(P>0.05)。结论在骨质疏松伴腰椎退变性疾病患者的治疗中,CBT和PMMA两种方法均能起到有效的固定效果,能有效改善患者的疼痛和腰椎功能障碍,而CBT相对而言,损伤小,且手术耗时短。

Objective To compare the efficacies of cortical bone screws(cortical bone trajectory,CBT)and cement augmented pedicle screw(polymethylmethacrylate,PMMA)instrumentation in the treatment of osteoporosis with lumbar degenerative disease.Methods A total of 80 patients with osteoporosis with lumbar degenerative disease who underwent posterior lumbar interbody fusion internal fixation in our hospital from January 2019 to September 2020 were selected as the study subjects.They were randomly divided into the observation group(n=40)and the control group(n=40).Patients in the control group were treated with PMMA fixation technique,while patients in the observation group were treated with CBT fixation technique.The operation duration and intraoperative blood loss were recorded,and the improvement of patients'symptoms and pain was assessed by using the Visual Analogue Scale/Score(VAS)and the Oswestry Dysfunction Index(ODI).The bone graft fusion rate and postoperative complications such as nerve injury,wound infection and screw loosening in both groups were counted after 1 year of follow-up.Results The operation duration of the observation group was shorter than that of the control group,and the blood loss was also less than that of the control group,with statistically significant differences(P<0.05).Before treatment,there were no statistically significant differences between the two groups in terms of VAS score and ODI score(P>0.05).After treatment,the VAS score and ODI score of the two groups were lower than those before treatment,with statistically significant differences(P<0.05).Meanwhile,there were no statistically significant differences between the two groups in terms of VAS score and ODI score(P<0.05).There were no statistically significant differences in the bone graft fusion rate and the incidence of postoperative complications between the two groups(P>0.05).Conclusion In the treatment of patients with osteoporosis with lumbar degenerative disease,both CBT and PMMA have effective fixation effect and can effectively improve patients'pain and lumbar spine dysfunction,while CBT is relatively less invasive and has a shorter operative duration.