皮质骨轨迹螺钉内固定治疗老年骨质疏松性腰椎疾病

Cortical bone trajectory in elderly patients with osteoporosis of lumbar disease

背景:合并有骨质疏松的腰椎疾病患者由于骨量丢失及骨小梁结构破坏,使得传统椎弓根钉的把持力降低,容易造成螺钉松动、断裂及椎体高度丢失等并发症,是腰椎手术常见失败的原因之一。目的:探讨皮质骨轨迹螺钉固定治疗骨质疏松性腰椎疾病的效果。方法:将2019年1月至2020年2月南昌大学第三附属医院收治的60例骨质疏松性腰椎疾病患者随机分成2组,对照组采用传统椎弓根螺钉固定,观察组采用皮质骨轨迹螺钉固定,两组均行腰椎后路融合治疗。记录两组患者手术时间、术中出血量、术后引流量、术后椎体融合率及并发症发生情况,对比术前、术后3,6个月腰椎神经功能日本骨科学会评分。结果与结论:(1)两组术后椎体融合率相比差异无显著性意义(P>0.05);(2)观察组的手术时间、术中出血量及术后引流量均优于对照组(P<0.05);(3)术后对照组有6例患者发生并发症,其中2例内固定失败,2例感染,2例脑脊液漏;观察组无并发症发生;(4)观察组术后3,6个月腰椎日本骨科学会评分均优于传统椎弓根螺钉组(P<0.05);(5)提示与传统椎弓根螺钉相比,皮质骨轨迹螺钉不仅能明显改善腰椎功能,还能减少手术时间、术中出血量及术后引流量,降低术中并发症发生率。

BACKGROUND:In patients with lumbar spine disease combined with osteoporosis,the loss of bone mass and the destruction of trabecular bone structure reduce the holding power of traditional pedicle screws,which can easily cause complications,such as screw loosening,fracture,and loss of vertebral body height.It is one of the common reasons for the failure of lumbar spine surgery.OBJECTIVE:To explore the effect of cortical bone trajectory in osteoporosis of lumbar disease.METHODS:From January 2019 to February 2020,60 patients with osteoporosis of lumbar disease in the Third Affiliated Hospital of Nanchang University were randomly divided into two groups.The control group received the fixation with traditional pedicle screw.The observation group received the fixation with cortical bone screws.Both groups were treated with posterior lumbar fusion.Operation time,intraoperative blood loss,postoperative drainage volume,vertebral fusion rate after operation,and any related complications were recorded in the two groups.Japanese Orthopaedic Association scores were compared preoperatively and 3 and 6 months postoperatively.RESULTS AND CONCLUSION:(1)There was no statistically significant difference in the fusion rate between the two groups(P>0.05).(2)Operation time,intraoperative blood loss,and postoperative drainage volume were better in the observation group than those in the control group(P<0.05).(3)After surgery,in the control group,complications occurred in six patients,including failure of internal fixation in two cases,infection in two cases and cerebrospinal fluid leakage in two cases.There was no complication in the observation group.(4)Japanese Orthopaedic Association scores were better in the observation group than those in the control group at 3 and 6 months postoperatively(P<0.05).(5)It is indicated that compared with traditional pedicle screw fixation,cortical bone trajectory can not only significantly improve the symptoms of lumbar disease,but also reduce operation time,intraoperative blood loss and postoperative drainage volume,and reduce intraoperative complications.