摘要
背景:在骨质疏松性腰椎后路融合术中,若采用常规的椎弓根螺钉固定方法则略显固定效力不足,易产生螺钉松动、移位、脱出,甚至导致螺钉切割骨质而引发椎弓根发生骨折断裂等并发症。目的:介绍皮质骨通道螺钉在骨质疏松性腰椎后路融合术中的应用方法,并评价其应用价值。方法:回顾性分析16例腰椎退行性病变患者的临床资料,采用皮质骨通道螺钉结合腰椎后路融合术治疗。观察并记录患者的手术时间、术中出血量、术中及术后并发症发生情况;术前、术后、末次随访时以目测类比评分法评估患者疼痛,以腰椎日本骨科学会评分评估患者的腰椎功能;末次随访时观察植骨融合情况并计算融合率。结果与结论:(1)患者手术均顺利安全完成,术中未出现神经、血管损伤等并发症及置钉相关的螺钉把持力不足或钉道破坏等导致置钉失败;术后随访中亦未出现螺钉松动、脱落、融合器移位等并发症;(2)手术时间为(168.5±37.1)min,术中出血量为(184.2±25.9)mL;(3)术后与末次随访时的目测类比评分、日本骨科学会评分均较术前显著改善(P<0.05),而术后与末次随访时比较差异则无显著性意义(P>0.05);(4)末次随访时所有患者均融合器在位、融合满意,融合率达100%;(5)提示采用皮质骨通道螺钉结合腰椎后路融合术治疗骨质疏松性腰椎退行性病变,固定牢固,无置钉相关并发症,不失为一种较好的置钉方法。
BACKGROUND： Conventional pedicle screw fixation is not appropriate for osteoporotic lumbar posterior fusion surgery, because of screw loosening, displacement, and prolapse, and pedicle fractures caused by screw-broken cortical bone.OBJECTIVE： To introduce the application of cortical bone trajectory（CBT） screws in the posterior lumbar fusion surgery of osteoporosis and to evaluate its application value. METHODS： Clinical data of 16 patients with degenerative lumbar spine undergoing CBT screws combined with posterior lumbar fusion surgery were retrospectively analyzed. The operation time, intraoperative blood loss, intraoperative and postoperative complications were recorded. The preoperative, postoperative and last-follow-up Visual Analogue Scale scores were used to assess the pain and the Japanese Orthopaedic Association score was used to assess the lumber function. The bone graft fusion and fusion rate at the last follow-up were observed and calculated, respectively. RESULTS AND CONCLUSION：（1） The surgery was successful in each patient. No complications such as nerve and blood vessel injuries, and the screw failure caused by insufficient screw holding force or nail path damage occurred. There was none case of screw loosening, shedding, or displacement during follow-up.（2） The operation time was（168.5±37.1） minutes and the intraoperative blood loss was（184.2±25.9） m L.（3） The Visual Analogue Scale and Japanese Orthopaedic Association scores postoperatively and at last follow-up were significantly improved compared with those at baseline（P 〈 0.05）, and the scores showed no significant differences postoperatively and last follow-up（P 〉 0.05）.（4） At the last follow-up, the fusion cages were in place, and fusion was satisfactory with a fusion rate of 100%.（5） In summary, the combination of CBT screws and posterior lumbar fusion surgery in the treatment of osteoporotic lumbar degenerative lesions can obtain a good fixation effect without screw-related complications, so it is a satisfactory placement method.
作者
郝申申
李长红
刘志斌
王飞
Hao Shen-shen;Li Chang-hong;Liu Zhi-bin;Wang Fei(Department of Spine Surgery,Affiliated Hospital of Yan’an University,Yan’an 716000,Shaanxi Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2018年第23期3628-3633,共6页
Chinese Journal of Tissue Engineering Research
基金
延安市科技攻关计划项目(2017KS-06)
陕西省社会发展科技攻关项目(2015SF115)
延安市科技惠民计划项目(2016HM-10-03)~~
