郑武 林院 黄少辉

【摘要】 目的：探討皮质骨轨迹（cortical bone trajectory，CBT）螺钉固定技术在腰椎手术中的应用优势和临床疗效。方法：回顾性分析2016年6月-2017年8月在本院应用皮质骨螺钉固定技术行腰椎融合术的12例患者资料，患者术前均摄胸腰椎正侧位X线片，并行CT扫描及MR检查。记录手术时间、术中出血量、手术并发症等。应用视觉模拟评分法（visual analogue scale，VAS）记录术前、各次随访时腰腿痛情况，应用Oswestry功能障碍指数（Oswestry disability index，ODI）问卷表，评估患者手术后功能改善情况。结果：12例患者手术时间130～320 min，平均（205.4±45.4）min；术中出血100～500 mL，平均（275.0±105.5）mL。1例术中腰椎皮下血肿，术后予清创缝合等治疗后，切口愈合，无双下肢疼痛无力，其余患者无术中和术后并发症。术前VAS腰痛评分（4.1±1.0）分，末次随访为（1.9±0.6）分，比较差异有统计学意义（t=8.006，P<0.01）；术前VAS腿痛评分（3.2±0.3）分，末次随访为（0.7±0.2）分，比较差异有统计学意义（t=4.855，P<0.01）；术前ODI评分（34.2±2.1）分，末次随访（10.8±2.9）分，比较差异有统计学意义（t=20.642，P<0.01）。所有患者腰腿痛症状均获得缓解，躯体功能改善满意。结论：CBT螺钉固定技术在腰椎手术中可获得良好疗效，可作为腰椎疾病外科治疗的补充内固定技术。

【关键词】 皮质骨螺钉； 腰椎手术； 内固定； 临床疗效

【Abstract】 Objective：To investigate the advantages and clinical effects of cortical bone trajectory screw fixation in lumbar surgery.Method：The data of 12 cases of lumbar interbody fusion with cortical bone screw fixation in our hospital from June 2016 to August 2017 were analyzed retrospectively.All patients underwent chest and lumbar lateral and anteroposterior X-ray films，CT scan and MR examination.The operative time，intraoperative blood loss and operative complications were recorded.The visual analogue scale （VAS） was used to record the lumbago and leg pain before and after the operation.The Oswestry disability index （ODI）questionnaire was used to evaluate the postoperative function improvement of the patients.Result：The operation time of 12 patients ranged from 130 to 320 minutes，with an average time of （205.4±45.4） minutes；intraoperative bleeding ranged from 100 to 500 mL， with an average of （275.0±105.5） mL.One case of intraoperative lumbar subcutaneous hematoma was treated with debridement and suture after operation.The incision healed without pain of both lower limbs，and the rest of the patients had no postoperative complications.The follow-up period was 8-21 months，with an average of （16.8±4.6）months.The preoperative VAS score of low back pain was （4.1±1.0） scores and the last follow-up was （1.9±0.6） scores，the difference was statistically significant （t=8.006，P<0.01）.The preoperative VAS score of leg pain was （3.2±0.3）scores and the last follow-up VAS score was （0.7±0.2）scores，the difference was also statistically significant （t=4.855，P<0.01）.The preoperative ODI score was （34.2±2.1） scores，the last follow-up was （10.8±2.9） scores，the difference was statistically significant （t=20.642，P<0.01）.All patients were relieved of symptoms of lumbago and leg pain，and their physical function were improved satisfactorily.Conclusion：Cortical bone trajectory screw fixation technique can achieve good results in lumbar surgery， and can be used as a supplementary internal fixation technique in the surgical treatment of lumbar diseases.

【Key words】 Cortical screw； Lumbar surgery； Internal fixation； Clinical efficacy

First-authors address：Fujian Medical University Fujian Provincial Hospital，Fuzhou 350001，China

doi：10.3969/j.issn.1674-4985.2018.31.035

椎弓根螺钉内固定技术能贯穿脊柱前、中、后三柱，起到三维矫形和固定作用，目前已在脊柱外科中广泛应用。但是传统椎弓根螺钉置入时，为暴露骨性标志而对肌肉剥离的程度较大，尤其在下腰椎和骶骨进行操作时，则需更充分地暴露。对于骨质疏松患者，因骨量减少、骨组织结构退化容易导致螺钉松动导致内置物稳定性下降，对于二次翻修或常规椎弓根螺钉置钉失败后进行重新置钉更是一种挑战。2009年，文献[1-2]报道了一种崭新的置钉方法—皮质骨螺钉技术（cortical bone trajectory，CBT）。CBT通过偏外及上倾置钉可更大程度地利用椎弓根复合体的皮质骨部分，保证螺钉更多表面部分与皮质骨相互嵌合，大大增加螺钉在钉道中的把持力，取代了传统椎弓根钉道（traditional trajectory，TT）利用椎弓根长轴作为通道，对于二次翻修或常规椎弓根螺钉置钉失败后补救性置钉提供了一种新的思路。……