皮质骨轨迹椎弓根螺钉在腰椎后路融合术后邻椎病中的应用

Application of Cortical Bone Trajectory Screws in Adjacent Segment Disease after Posterior Lumbar Interbody Fusion

目的:探讨皮质骨轨迹(CBT)椎弓根螺钉治疗腰椎后路融合术后邻椎病(ASD)的疗效和优势。方法:回顾性分析2017年9月至2021年7月应用皮质骨轨迹椎弓根螺钉治疗邻椎病23例患者临床资料。其中男7例,女16例;年龄为58~81岁;与初次手术间隔时间为1.7~10.0年。统计患者体重指数(BMI)、手术节段、手术时间、术中出血量、手术并发症等。通过影像学检查判断是否发生内固定松动、假关节形成和再次邻近节段退变。比较术前及末次随访时腰痛和腿痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评分,评估患者手术前后疼痛缓解和功能改善情况。结果:所有患者均顺利完成手术,手术时间为(210±38)min;术中出血量平均为309 mL(300~400 mL)。2例术后并发急性膀胱炎,给予抗感染后治愈。未出现螺钉松动及假关节形成等内固定相关并发症,未再次出现症状性邻近节段退变。术前患者腰痛VAS评分为(4.8±1.1)分,腿痛评分为(6.1±1.6)分,ODI评分为50.6%±8.3%。末次随访患者腰痛VAS评分为(1.7±0.5)分,腿痛评分为(1.3±0.4)分,ODI评分为13.5%±5.1%。所有患者随访时间平均为37个月(17~52个月),末次随访患者各指标评分均较术前明显改善,差异有统计学意义(P<0.01),总体临床效果满意。结论:皮质骨轨迹椎弓根螺钉应用于腰椎术后邻椎病,有损伤小、抗拔出力强的优势,可作为腰椎邻椎病手术方案。

Objective:To investigate the efficacy and advantages of the cortical bone trajectory(CBT)pedicle screw in the treatment of adjacent segment disease(ASD)after posterior lumbar fusion.Methods:The clinical data of 23 patients with ASD treated with CBT pedicle screw from September 2017 to July 2021 were retrospectively analyzed,including 7 males and 16 females,aged 58 to 81 years old,and the interval between the initial operation was 1.7 to 10.0 years.Body mass index(BMI),surgical segment,operation time,intraoperative blood loss,and surgical complications were counted.The occurrence of internal fixation loosening,pseudoarthrosis to ASD was determined by imaging examination.The visual analog scale(VAS)and Oswestry disability index(ODI)scores for low back and leg pain were compared before and at the last follow-up to evaluate the pain relief and functional improvement of the patients before and after surgery.Results:All 23 cases were completed,the operation time was(210±38)min,and the intraoperative blood loss was 309 mL(300 to 400 mL).One case of postoperative acute cystitis was cured after antibiotic treatment.There were no internal fixation-related complications such as screw loosening and pseudoarthrosis,and no symptomatic adjacent segment degeneration occurred again.Before surgery,the low back pain VAS score was(4.8±1.1)points,the leg pain VAS score was(6.1±1.6)points,and the ODI score was 50.6%±8.3%.At the last follow-up,the low back pain VAS score was(1.7±0.5)points,the leg pain VAS score was(1.3±0.4)points,and the ODI score was 13.5%±5.1%.All patients were followed up for 37 months(17 to 52 months).The scores of each index in the last follow-up were significantly improved compared with those before the operation,and the differences were statistically significant(P<0.01).The overall clinical effect was satisfactory.Conclusion:The cortical bone trajectory pedicle screw has the advantages of less damage and strong pullout resistance in adjacent spondylosis after lumbar surgery and can be used as a revision surgery plan for lumbar ASD.