皮质骨螺钉与椎弓根螺钉内固定在创伤性胸腰椎骨折手术中的临床应用对比

A comparative study on the application of cortical bone screw and pedicle screw fixation in treating traumatic thoracolumbar fractures

目的:探索比较皮质骨轨迹螺钉(cortical bone trajectory screw,CBT)与椎弓根螺钉(pedicle screw,PS)在创伤性胸腰椎骨折患者后路脊柱固定术中的临床应用效果。方法:按照纳入排除标准,回顾性收集中国人民解放军陆军第九五八医院2018年2月至2020年2月行后路皮质骨螺钉固定融合术(CBT组)及后路椎弓根螺钉固定融合术(PS组)的不稳定创伤性胸腰椎骨折患者的病例资料,共纳入50例患者,其中CBT组22例(男13例,女9例),平均年龄57.45岁;PS组28例(男15例,女13例),平均年龄为55.11岁,随访时间为(1.36±0.27)年。记录并分析对比CBT组和PS组患者临床与影像学参数。临床资料包括患者性别、年龄、AO分型、手术时间、手术失血量、术后住院日、术后切口感染、内固定松动等并发症发生率、术前术后及末次随访疼痛视觉模拟评分法(Visual Analogue Score,VAS)及Oswestry功能障碍指数(Oswestry Disability Index,ODI)评分。影像学资料包括患者术前术后及随访过程中伤椎椎体前缘高度变化、固定节段随访期间Cobb角变化。对纳入患者进行组间与组内前后自身对照。结果:CBT组患者平均手术时间为178.64 min,平均术中出血量为139.55 mL,术后平均住院时间为3.05 d;PS组患者平均术中出血量为191.79 mL,术后平均住院时间为4.04 d,均显著高于CBT组(均P<0.01)。随访期间2组患者固定节段局部后凸角及椎体前缘高度术后较术前显著改善,而末次随访较术后无显著变化,2组间差异无统计学意义(均P>0.05)。2组VAS评分与ODI评分术后较术前、末次随访较术后均显著改善,但2组间差异均无统计学意义(均P>0.05)。2组患者均未出现切口感染而导致翻修手术,影像学资料未见明显内固定松动及内固定失败征象。结论:CBT可以有效对骨折节段进行固定,患者可获得明显的临床改善,在成人创伤性胸腰椎骨折的固定手术中,CBT内固定是传统PS的一种安全、有效的替代方式。

Objective:This study aims to compare the clinical outcomes of cortical bone trajectory screw(CBT)and pedicle screw(PS)in posterior spinal fixation in patients with traumatic thoracolumbar fractures.Methods:According to the inclusion and exclusion criteria,the patients with unstable traumatic thoracolumbar fractures who underwent posterior cortical bone trajectory screw fixation and fusion(CBT group)and posterior pedicle screw fixation and fusion(PS group)in the 958th Hospital of the PLA Army from February 2018 to February 2020 were retrospectively collected.A total of 50 patients were included according to the inclusion and exclusion criteria,including 22 patients in the CBT group(13 males and 9 females)with an average age of 57.45 years,and 28 patients in the PS group(15 males and 13 females)with an average age of 55.11 age.The average follow-up duration was(1.36±0.27)years.The clinical and radiological parameters of patients in the CBT group and the PS group were recorded and analyzed.Clinical data included gender,age,AO classification,operation duration,estimated blood loss,hospital stay,Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)pre-and post-operation and at the last follow-up.The radiological data included the changes of the anterior vertebral height of the injured vertebral body pre-and post-operation and during the follow-up,and the changes of the Cobb angle of the fixed segment.The included patients were compared pre-and postoperation between the groups and within the group.Results:The average surgical time in the CBT group was 178.64 min,the average estimated blood loss in the CBT group was 139.55 mL,and the average postoperative hospital stay was 3.05 d;the average estimated blood loss in the PS group was 191.79 mL,the postoperative hospital stay was 4.04 days,which were significantly higher than those in the CBT group(all P<0.01).During the follow-up,the local kyphosis angle of the fixed segment and the anterior vertebral height in the 2 groups were significantly improved after surgery compared with those before surgery,but there was no significant change at the last follow-up,and there was no statistical difference between the 2 groups(all P>0.05).The VAS scores and ODI scores in the 2 groups were significantly improved after surgery compared with preoperative and last follow-up,but there was no statistical difference between the 2 groups(all P>0.05).In the 2 groups,no patient received revision surgery because of incision infection,and no obvious signs of fixation loosening and failure were found.Conclusion:CBT screws can effectively fix fracture segments,and patients can obtain significant clinical improvement.In the fixation of adult traumatic thoracolumbar fractures,CBT screw fixation is a safe and effective alternative to traditional PS.