Lumbar degenerative disc disease(DDD)in the elderly population remains a global health problem,especially in patients with osteoporosis.Osteoporosis in the elderly can cause failure of internal fixation.Cortical bone ...Lumbar degenerative disc disease(DDD)in the elderly population remains a global health problem,especially in patients with osteoporosis.Osteoporosis in the elderly can cause failure of internal fixation.Cortical bone trajectory(CBT)is an effective,safe and minimally invasive technique for the treatment of lumbar DDD in patients with osteoporosis.In this review,we analyzed the anatomy,biomechanics,and advantages of the CBT technique in lumbar DDD and revision surgery.Additionally,the clinical trials and case reports,indications,advancements and limitations of this technique were further discussed and reviewed.Finally,we concluded that the CBT technique can be a practical,effective and safe alternative to traditional pedicle screw fixation,especially in DDD patients with osteoporosis.展开更多
Posterior lumbar interbody fusion (PLIF) is a common surgical procedure and widely used in the treatment of lumbar degenerative disc disorders. Traditionally, posterior lumbar interbody fusion is done by using the tra...Posterior lumbar interbody fusion (PLIF) is a common surgical procedure and widely used in the treatment of lumbar degenerative disc disorders. Traditionally, posterior lumbar interbody fusion is done by using the traditional pedicle screw (PS) which offers great advantages, but at the same time it has some disadvantages which include the risk of superior facet joint violation and muscle damage. Recently, an alternative method of screw insertion via cortical bone trajectory (CBT) has been invented which has less invasive process and can be placed without the drawbacks associated with the traditional pedicle screw. However, it has to remain an interest whether CBT will provide similar or greater clinical outcomes compared to PS in PLIF. So the main aim of this review is to compare the clinical outcomes of cortical bone trajectory and traditional pedicle screw fixation in posterior lumbar interbody fusion based on the articles published on this topic. Compared to the traditional pedicle screw fixation, PLIF with CBT has similar clinical outcome based on pain intensity, ODI status and JOA score, as well as similar fusion rate and radiological evaluated complication such as loosening of screw. In addition PLIF with CBT has advantages of less facet joint violation, less blood loss, less intraoperative muscle damage and perioperative pain. On the basis of this study, we can suggest that PLIF with CBT can be considered as a reasonable alternative to PS in PLIF.展开更多
BACKGROUND The incidence of lumbar tuberculosis is high worldwide,and effective treatment is a continuing problem.AIM To study the safety and efficacy of the multitrack and multianchor point screw technique combined w...BACKGROUND The incidence of lumbar tuberculosis is high worldwide,and effective treatment is a continuing problem.AIM To study the safety and efficacy of the multitrack and multianchor point screw technique combined with the contralateral Wiltse approach for lesion debridement to treat lumbar tuberculosis.METHODS The C-reactive protein(CRP)level,erythrocyte sedimentation rate(ESR),visual analogue scale(VAS)score,oswestry disability index(ODI)and American Spinal Injury Association(ASIA)grade were recorded and analysed pre-and postoperatively.RESULTS The CRP level and ESR returned to normal,and the VAS score and ODI were decreased at 3 mo postoperatively,with significant differences compared with the preoperative values(P<0.01).Neurological dysfunction was relieved,and the ASIA grade increased,with no adverse events.CONCLUSION The multitrack,multianchor point screw fixation technique combined with the contralateral Wiltse approach for debridement is an effective and safe method for the treatment of lumbar tuberculosis.展开更多
Objective The purpose of this study was to demonstrate the lumbar pedicle cortical bone trajectory （CBT） screw fixation technique,a new fixation technique for lumbar surgery.Data sources The data analyzed in this re...Objective The purpose of this study was to demonstrate the lumbar pedicle cortical bone trajectory （CBT） screw fixation technique,a new fixation technique for lumbar surgery.Data sources The data analyzed in this review are mainly from articles reported in PubMed published from 1994 to 2014.Study selection Original articles and critical reviews relevant to CBT technique and lumbar pedicle fixation were selected.Results CBT technique was firstly introduced as a new fixation method for lumbar pedicle surgery in 2009.The concepts,morphometric study,biomechanical characteristics and clinical applications of CBT technique were reviewed.The insertional point of CBT screw is located at the lateral point of the pars interarticularis,and its trajectory follows a caudocephalad path sagittally and a laterally directed path in the transverse plane.CBT technique can be used for posterior fixation during lumbar fusion procedures.This technique is a minimally invasive surgery,which affords better biomechanical stability,fixation strength and surgical safety.Therefore,CBT technique has the greatest benefit in lumbar pedicle surgery for patients with osteoporosis and obesity.Conclusion CBT technique is a better alternative option of lumbar pedicle fixation,especially for patients with osteoporosis and obesity.展开更多
目的观察皮质骨通道螺钉固定A3型胸腰椎骨质疏松性椎体骨折的生物力学即刻稳定性。方法取6具新鲜老年尸体胸腰段脊柱标本,在MTS-858脊柱生物力学实验机上测试原始状态、传统固定、皮质骨通道螺钉(cortical bone trajectory,CBT)固定、...目的观察皮质骨通道螺钉固定A3型胸腰椎骨质疏松性椎体骨折的生物力学即刻稳定性。方法取6具新鲜老年尸体胸腰段脊柱标本,在MTS-858脊柱生物力学实验机上测试原始状态、传统固定、皮质骨通道螺钉(cortical bone trajectory,CBT)固定、骨折传统固定、骨折CBT固定五种工况下的L1～3的活动范围。结果传统固定组、CBT固定组的三维六自由度活动范围较原始状态组明显降低(P<0.01),传统固定组和CBT固定组之间没有显著差异。骨折传统固定组和骨折CBT固定组的三维活动总体上比原始状态组降低(P<0.05),但是骨折传统固定组和骨折CBT固定组之间差异无统计学意义。骨折传统固定组和骨折CBT固定组的三维活动,分别比传统固定组和CBT固定组之间的三维活动有所增加,但是差异无统计学意义(P>0.05)。结论骨折后CBT螺钉固定可获得与骨折后普通椎弓根螺钉固定相似的即刻稳定性,CBT螺钉固定可用于老年A3型骨质疏松性胸腰椎骨折的临床治疗。展开更多
目的对比骨科手术机器人辅助与徒手皮质骨螺钉置钉在脊柱内固定手术中的安全性与准确性。方法回顾分析2019年12月至2021年6月于首都医科大学附属北京朝阳医院骨科接受皮质骨轨迹螺钉(cortical bone trajectory,CBT)治疗单节段退行性腰...目的对比骨科手术机器人辅助与徒手皮质骨螺钉置钉在脊柱内固定手术中的安全性与准确性。方法回顾分析2019年12月至2021年6月于首都医科大学附属北京朝阳医院骨科接受皮质骨轨迹螺钉(cortical bone trajectory,CBT)治疗单节段退行性腰椎疾病的71例患者。将接受X线透视辅助徒手CBT螺钉置入的患者作为徒手组(n=35),接受机器人辅助CBT螺钉置入的作为机器人组(n=36)。螺钉置钉准确性和关节突侵犯情况通过术后电子计算机断层扫描(computed tomography,CT)三维重建评估。对比两组平均单枚螺钉的置钉时间、术中出血量及医务人员术中射线暴露情况。结果71例患者一共植入284枚CBT螺钉,其中140枚由徒手组完成,144枚由机器人组完成。机器人组的准确率显著高于徒手组(92.36%vs 82.86%,P=0.015)。机器人组关节突侵犯发生率显著低于徒手组(22.22%vs 40.00%,P=0.022)。但是,单颗螺钉置钉时间机器人组显著长于徒手组[(501.92±70.08)s vs(382.54±63.21)s,P=0.000]。术中医务人员辐射暴露时间徒手组明显高于机器人组[(56.81±16.09)s vs(34.43±16.91)s,P=0.000]。结论机器人辅助植入CBT螺钉可以有效提高螺钉置入准确性并减少了上关节突的侵犯率和医务人员的辐射暴露,但会增加螺钉的置钉时间与手术时间。本中心大约在12台手术后获得了平稳的机器人辅助CBT技术学习曲线。展开更多
背景:探讨皮质骨轨迹螺钉的研究现状及发展趋势,了解皮质骨轨迹螺钉的研究方向及热点,有助于研究者把握该领域最新信息及发展趋势。目的:探究皮质骨轨迹螺钉的国际研究现状以及未来的发展趋势。方法:在Web of Science核心合集数据库中检...背景:探讨皮质骨轨迹螺钉的研究现状及发展趋势,了解皮质骨轨迹螺钉的研究方向及热点,有助于研究者把握该领域最新信息及发展趋势。目的:探究皮质骨轨迹螺钉的国际研究现状以及未来的发展趋势。方法:在Web of Science核心合集数据库中检索2000-01-01/2021-10-28期间发表的与皮质骨轨迹螺钉相关的英文文献,采用文献计量方法对收集到的文献进行统计和分析,采用VOS viewer软件对这些文献进行可视化研究,分析皮质骨轨迹螺钉的研究热点及发展趋势。结果与结论:①共纳入426篇文献,皮质骨轨迹螺钉的全球研究发表量逐年增加,2020年发表文章最多,共发表文章64篇;其中美国发文量最多,对全球贡献最大,居第1位(172篇),中国发文量为84篇,排在第2位;②《WORLD NEUROSURGERY》刊出的相关论文数量最多,为33篇;美国国立卫生研究院及美国卫生人类服务部是基金资助最多的2个机构;③MATSUKAWA K是发表文章最多的作者,为19篇,YATO Y排在第2位,发表文章为14篇;④从皮质骨轨迹螺钉研究的可视化分析来看,对该领域的研究还有很大的探索空间,文章发表数量将不断增加,美国和日本在这一领域处于领先地位,中国紧随其后,近年来的研究方向主要集中在皮质骨轨迹螺钉手术治疗方面。展开更多
目的 比较皮质骨轨迹(cortical bone trajectory,CBT)和传统轨迹(traditional trajectory,TT)椎弓根螺钉内固定对正常和骨质疏松性脊柱活动度(range of motion,ROM)和钉棒系统受力的影响。方法 建立正常骨质和骨质疏松腰椎L3~S1有限元模...目的 比较皮质骨轨迹(cortical bone trajectory,CBT)和传统轨迹(traditional trajectory,TT)椎弓根螺钉内固定对正常和骨质疏松性脊柱活动度(range of motion,ROM)和钉棒系统受力的影响。方法 建立正常骨质和骨质疏松腰椎L3~S1有限元模型,使用两种轨迹的螺钉钉棒系统对L4~5节段进行内固定,分别模拟人体前屈、后伸、左右侧弯和左右旋转6种生理载荷,对比两种内固定术式对正常和骨质疏松脊柱ROM和螺钉最大等效应力的影响。结果 对于两种骨质情况,相比于未置钉的节段模型,CBT和TT手术均显著降低了固定节段(L4~5)和下腰椎整个节段(L3~S1)ROM;但是,CBT组较TT组ROM下降的幅度略小,两者在屈伸时相近,而在侧弯和轴向旋转时差别明显;此外,在正常骨质模型和骨质疏松模型中,CBT组螺钉最大等效应力均较TT组有明显增加,正常骨质模型中CBT组螺钉最大等效应力在屈伸、侧弯、轴向旋转时比TT组分别提高27%、268%、58%。但在同时采用CBT技术时,骨质疏松模型较正常骨质模型有更小的螺钉应力分布。结论 骨质疏松条件下,相比于TT技术,CBT技术可以实现较高的螺钉应力,降低正常骨质条件下的螺钉应力集中;另外,CBT技术略微增加了各节段ROM,有利于术后脊柱生理功能的恢复。侧弯和轴向旋转会产生负面的力学效果,应避免这两种生理载荷。展开更多
背景:关于单个皮质骨轨迹螺钉的生物力学研究国内外已有多篇文章报道,但关于椎体、融合器、钉棒整个运动单元的生物力学研究,特别是关于皮质骨轨迹螺钉联合传统椎弓根螺钉(cortical bone trajectory combined with pedicle screw,CBTPS...背景:关于单个皮质骨轨迹螺钉的生物力学研究国内外已有多篇文章报道,但关于椎体、融合器、钉棒整个运动单元的生物力学研究,特别是关于皮质骨轨迹螺钉联合传统椎弓根螺钉(cortical bone trajectory combined with pedicle screw,CBTPS)固定方式对运动单元的应力分布情况及内固定装置稳定性的相关研究报道并不多。目的:归纳分析传统椎弓根螺钉固定与CBTPS固定骨质疏松椎体运动单元上的生物力学差异。方法:基于一位骨质疏松志愿者(骨密度T值<-0.25 SD)的CT数据,建立L3到骶椎椎体功能单元骨质疏松有限元模型。通过有效性验证后,建立传统椎弓根螺钉和CBTPS两种固定模型,比较两种模型在前屈、后伸、左右侧屈、左右旋转6种工况下内固定的应力及椎体运动单元活动情况;比较两种内固定方式下运动单元的应力分布情况及内固定装置的稳定性。结果与结论:(1)有限元验证结果显示,模型可较好地模拟骨质疏松患者腰椎的生理活动。(2)两组模型在屈曲、后伸状态下,内固定装置最大应力接近,但是CBTPS组内固定装置在侧屈与旋转状态下钉棒系统最大应力值要大于传统椎弓根螺钉组,其中侧屈时,CBTPS组较传统椎弓根螺钉组增加了11.5%,在旋转时,CBTPS组较传统椎弓根螺钉组增加了25.2%。CBTPS组cage的应力均大于传统椎弓根螺钉组,其中侧屈时,CBTPS组较传统椎弓根螺钉组增加了17%,在旋转时,CBTPS组较传统椎弓根螺钉组增加了15%。(3)两组模型在静载、前屈、后伸、侧屈、旋转状态下,椎间活动度相当,两种内固定装置能提供相似的稳定性。(4)总得来说,两种固定方式均可加强腰椎融合节段的固定强度,提供类似的节段稳定性,但CBTPS内固定方式可进一步加强融合节段的力学强度,提供更好的融合应力环境。展开更多
目的:探讨对于腰椎管狭窄症且行单节段减压融合的患者,机器人辅助下的皮质骨螺钉(robot-assisted cortical bone trajectory screw,RCBTS)固定与机器人辅助下的椎弓根螺钉(robot-assisted pedicle screw,RPS)固定的疗效差异。方法:本研...目的:探讨对于腰椎管狭窄症且行单节段减压融合的患者,机器人辅助下的皮质骨螺钉(robot-assisted cortical bone trajectory screw,RCBTS)固定与机器人辅助下的椎弓根螺钉(robot-assisted pedicle screw,RPS)固定的疗效差异。方法:本研究为回顾性队列研究,回顾了2020年6月~2022年月6月于首都医科大学附属北京世纪坛医院行单节段减压融合且行机器人辅助下置钉的腰椎管狭窄症患者,共纳入99例,其中男性59例,女性40例,平均年龄67.07±4.65岁;应用皮质骨螺钉固定者41例(RCBTS组),应用椎弓根螺钉固定者58例(RPS组)。比较两种不同术式的切口长度、手术时间、术中出血量、术后的24h引流量、术后住院天数;比较术后3d、3个月、6个月的日本骨科协会(Japanese Orthopaedic Association,JOA)评分和腰痛视觉模拟评分(visual analogue scale,VAS),并对JOA评分和VAS评分变化进行了固定效应检验;通过审查术后影像学资料,根据Gertzbein-Robbins方法对螺钉位置进行分级,计算两种术式的置钉准确率;比较两种术式围术期以及术后3个月的并发症发生情况。结果:两组患者基线数据无统计学差异(P>0.05)。RCBTS组患者的手术时长(134.39±22.23min vs 152.93±19.10min,P<0.001)、切口长度(64.93±3.71mm vs 78.84±3.82mm,P<0.001)、术中出血(155.61±37.15mL vs 172.41±43.22mL,P=0.001)、术后24h引流量(83.66±21.54mL vs 101.21±29.80mL,P=0.002)以及术后住院天数(4.90±1.26d vs 6.26±1.66d,P<0.001)均显著小于RPS组患者。两组患者的JOA评分和VAS评分变化在各时间点无显著性差异(P>0.05)。固定效应检验结果表明时间是JOA和VAS评分变化的固定效应(P<0.001)。两组的各级别置钉率(A级:152/164 vs 211/232,P=0.538;B级:9/164 vs 15/232,P=0.688;C级:3/164 vs 6/232,P=0.619)、临床可接受率(161/164 vs 226/232,P=0.619)、置钉不良率(3/164 vs 6/232,P=0.619)以及术后并发症(仅RCBTS组一例患者出现伤口延迟愈合)的发生情况均无显著性差异(P>0.05)。结论:与RPS相比,接受RCBTS的患者在手术时间、切口长度、术中出血量、术后引流量以及术后住院时长方面均具有显著优势;在术后功能恢复和腰痛改善间两组没有显著差异。展开更多
基金Supported by National Natural Science Foundation of China,No.82202694。
文摘Lumbar degenerative disc disease(DDD)in the elderly population remains a global health problem,especially in patients with osteoporosis.Osteoporosis in the elderly can cause failure of internal fixation.Cortical bone trajectory(CBT)is an effective,safe and minimally invasive technique for the treatment of lumbar DDD in patients with osteoporosis.In this review,we analyzed the anatomy,biomechanics,and advantages of the CBT technique in lumbar DDD and revision surgery.Additionally,the clinical trials and case reports,indications,advancements and limitations of this technique were further discussed and reviewed.Finally,we concluded that the CBT technique can be a practical,effective and safe alternative to traditional pedicle screw fixation,especially in DDD patients with osteoporosis.
文摘Posterior lumbar interbody fusion (PLIF) is a common surgical procedure and widely used in the treatment of lumbar degenerative disc disorders. Traditionally, posterior lumbar interbody fusion is done by using the traditional pedicle screw (PS) which offers great advantages, but at the same time it has some disadvantages which include the risk of superior facet joint violation and muscle damage. Recently, an alternative method of screw insertion via cortical bone trajectory (CBT) has been invented which has less invasive process and can be placed without the drawbacks associated with the traditional pedicle screw. However, it has to remain an interest whether CBT will provide similar or greater clinical outcomes compared to PS in PLIF. So the main aim of this review is to compare the clinical outcomes of cortical bone trajectory and traditional pedicle screw fixation in posterior lumbar interbody fusion based on the articles published on this topic. Compared to the traditional pedicle screw fixation, PLIF with CBT has similar clinical outcome based on pain intensity, ODI status and JOA score, as well as similar fusion rate and radiological evaluated complication such as loosening of screw. In addition PLIF with CBT has advantages of less facet joint violation, less blood loss, less intraoperative muscle damage and perioperative pain. On the basis of this study, we can suggest that PLIF with CBT can be considered as a reasonable alternative to PS in PLIF.
基金Supported by 2023 Hebei Province Medical Science Research Project Plan,No.20231958。
文摘BACKGROUND The incidence of lumbar tuberculosis is high worldwide,and effective treatment is a continuing problem.AIM To study the safety and efficacy of the multitrack and multianchor point screw technique combined with the contralateral Wiltse approach for lesion debridement to treat lumbar tuberculosis.METHODS The C-reactive protein(CRP)level,erythrocyte sedimentation rate(ESR),visual analogue scale(VAS)score,oswestry disability index(ODI)and American Spinal Injury Association(ASIA)grade were recorded and analysed pre-and postoperatively.RESULTS The CRP level and ESR returned to normal,and the VAS score and ODI were decreased at 3 mo postoperatively,with significant differences compared with the preoperative values(P<0.01).Neurological dysfunction was relieved,and the ASIA grade increased,with no adverse events.CONCLUSION The multitrack,multianchor point screw fixation technique combined with the contralateral Wiltse approach for debridement is an effective and safe method for the treatment of lumbar tuberculosis.
文摘Objective The purpose of this study was to demonstrate the lumbar pedicle cortical bone trajectory （CBT） screw fixation technique,a new fixation technique for lumbar surgery.Data sources The data analyzed in this review are mainly from articles reported in PubMed published from 1994 to 2014.Study selection Original articles and critical reviews relevant to CBT technique and lumbar pedicle fixation were selected.Results CBT technique was firstly introduced as a new fixation method for lumbar pedicle surgery in 2009.The concepts,morphometric study,biomechanical characteristics and clinical applications of CBT technique were reviewed.The insertional point of CBT screw is located at the lateral point of the pars interarticularis,and its trajectory follows a caudocephalad path sagittally and a laterally directed path in the transverse plane.CBT technique can be used for posterior fixation during lumbar fusion procedures.This technique is a minimally invasive surgery,which affords better biomechanical stability,fixation strength and surgical safety.Therefore,CBT technique has the greatest benefit in lumbar pedicle surgery for patients with osteoporosis and obesity.Conclusion CBT technique is a better alternative option of lumbar pedicle fixation,especially for patients with osteoporosis and obesity.
文摘目的观察皮质骨通道螺钉固定A3型胸腰椎骨质疏松性椎体骨折的生物力学即刻稳定性。方法取6具新鲜老年尸体胸腰段脊柱标本,在MTS-858脊柱生物力学实验机上测试原始状态、传统固定、皮质骨通道螺钉(cortical bone trajectory,CBT)固定、骨折传统固定、骨折CBT固定五种工况下的L1～3的活动范围。结果传统固定组、CBT固定组的三维六自由度活动范围较原始状态组明显降低(P<0.01),传统固定组和CBT固定组之间没有显著差异。骨折传统固定组和骨折CBT固定组的三维活动总体上比原始状态组降低(P<0.05),但是骨折传统固定组和骨折CBT固定组之间差异无统计学意义。骨折传统固定组和骨折CBT固定组的三维活动,分别比传统固定组和CBT固定组之间的三维活动有所增加,但是差异无统计学意义(P>0.05)。结论骨折后CBT螺钉固定可获得与骨折后普通椎弓根螺钉固定相似的即刻稳定性,CBT螺钉固定可用于老年A3型骨质疏松性胸腰椎骨折的临床治疗。
文摘目的 比较皮质骨轨迹(cortical bone trajectory,CBT)和传统轨迹(traditional trajectory,TT)椎弓根螺钉内固定对正常和骨质疏松性脊柱活动度(range of motion,ROM)和钉棒系统受力的影响。方法 建立正常骨质和骨质疏松腰椎L3~S1有限元模型,使用两种轨迹的螺钉钉棒系统对L4~5节段进行内固定,分别模拟人体前屈、后伸、左右侧弯和左右旋转6种生理载荷,对比两种内固定术式对正常和骨质疏松脊柱ROM和螺钉最大等效应力的影响。结果 对于两种骨质情况,相比于未置钉的节段模型,CBT和TT手术均显著降低了固定节段(L4~5)和下腰椎整个节段(L3~S1)ROM;但是,CBT组较TT组ROM下降的幅度略小,两者在屈伸时相近,而在侧弯和轴向旋转时差别明显;此外,在正常骨质模型和骨质疏松模型中,CBT组螺钉最大等效应力均较TT组有明显增加,正常骨质模型中CBT组螺钉最大等效应力在屈伸、侧弯、轴向旋转时比TT组分别提高27%、268%、58%。但在同时采用CBT技术时,骨质疏松模型较正常骨质模型有更小的螺钉应力分布。结论 骨质疏松条件下,相比于TT技术,CBT技术可以实现较高的螺钉应力,降低正常骨质条件下的螺钉应力集中;另外,CBT技术略微增加了各节段ROM,有利于术后脊柱生理功能的恢复。侧弯和轴向旋转会产生负面的力学效果,应避免这两种生理载荷。
文摘背景:关于单个皮质骨轨迹螺钉的生物力学研究国内外已有多篇文章报道,但关于椎体、融合器、钉棒整个运动单元的生物力学研究,特别是关于皮质骨轨迹螺钉联合传统椎弓根螺钉(cortical bone trajectory combined with pedicle screw,CBTPS)固定方式对运动单元的应力分布情况及内固定装置稳定性的相关研究报道并不多。目的:归纳分析传统椎弓根螺钉固定与CBTPS固定骨质疏松椎体运动单元上的生物力学差异。方法:基于一位骨质疏松志愿者(骨密度T值<-0.25 SD)的CT数据,建立L3到骶椎椎体功能单元骨质疏松有限元模型。通过有效性验证后,建立传统椎弓根螺钉和CBTPS两种固定模型,比较两种模型在前屈、后伸、左右侧屈、左右旋转6种工况下内固定的应力及椎体运动单元活动情况;比较两种内固定方式下运动单元的应力分布情况及内固定装置的稳定性。结果与结论:(1)有限元验证结果显示,模型可较好地模拟骨质疏松患者腰椎的生理活动。(2)两组模型在屈曲、后伸状态下,内固定装置最大应力接近,但是CBTPS组内固定装置在侧屈与旋转状态下钉棒系统最大应力值要大于传统椎弓根螺钉组,其中侧屈时,CBTPS组较传统椎弓根螺钉组增加了11.5%,在旋转时,CBTPS组较传统椎弓根螺钉组增加了25.2%。CBTPS组cage的应力均大于传统椎弓根螺钉组,其中侧屈时,CBTPS组较传统椎弓根螺钉组增加了17%,在旋转时,CBTPS组较传统椎弓根螺钉组增加了15%。(3)两组模型在静载、前屈、后伸、侧屈、旋转状态下,椎间活动度相当,两种内固定装置能提供相似的稳定性。(4)总得来说,两种固定方式均可加强腰椎融合节段的固定强度,提供类似的节段稳定性,但CBTPS内固定方式可进一步加强融合节段的力学强度,提供更好的融合应力环境。
文摘目的:探讨对于腰椎管狭窄症且行单节段减压融合的患者,机器人辅助下的皮质骨螺钉(robot-assisted cortical bone trajectory screw,RCBTS)固定与机器人辅助下的椎弓根螺钉(robot-assisted pedicle screw,RPS)固定的疗效差异。方法:本研究为回顾性队列研究,回顾了2020年6月~2022年月6月于首都医科大学附属北京世纪坛医院行单节段减压融合且行机器人辅助下置钉的腰椎管狭窄症患者,共纳入99例,其中男性59例,女性40例,平均年龄67.07±4.65岁;应用皮质骨螺钉固定者41例(RCBTS组),应用椎弓根螺钉固定者58例(RPS组)。比较两种不同术式的切口长度、手术时间、术中出血量、术后的24h引流量、术后住院天数;比较术后3d、3个月、6个月的日本骨科协会(Japanese Orthopaedic Association,JOA)评分和腰痛视觉模拟评分(visual analogue scale,VAS),并对JOA评分和VAS评分变化进行了固定效应检验;通过审查术后影像学资料,根据Gertzbein-Robbins方法对螺钉位置进行分级,计算两种术式的置钉准确率;比较两种术式围术期以及术后3个月的并发症发生情况。结果:两组患者基线数据无统计学差异(P>0.05)。RCBTS组患者的手术时长(134.39±22.23min vs 152.93±19.10min,P<0.001)、切口长度(64.93±3.71mm vs 78.84±3.82mm,P<0.001)、术中出血(155.61±37.15mL vs 172.41±43.22mL,P=0.001)、术后24h引流量(83.66±21.54mL vs 101.21±29.80mL,P=0.002)以及术后住院天数(4.90±1.26d vs 6.26±1.66d,P<0.001)均显著小于RPS组患者。两组患者的JOA评分和VAS评分变化在各时间点无显著性差异(P>0.05)。固定效应检验结果表明时间是JOA和VAS评分变化的固定效应(P<0.001)。两组的各级别置钉率(A级:152/164 vs 211/232,P=0.538;B级:9/164 vs 15/232,P=0.688;C级:3/164 vs 6/232,P=0.619)、临床可接受率(161/164 vs 226/232,P=0.619)、置钉不良率(3/164 vs 6/232,P=0.619)以及术后并发症(仅RCBTS组一例患者出现伤口延迟愈合)的发生情况均无显著性差异(P>0.05)。结论:与RPS相比,接受RCBTS的患者在手术时间、切口长度、术中出血量、术后引流量以及术后住院时长方面均具有显著优势;在术后功能恢复和腰痛改善间两组没有显著差异。
