目的

对比分析皮质骨轨迹螺钉（CBT）与椎弓根螺钉（PS）固定的经椎间孔腰椎椎体间融合术（TLIF）治疗腰椎退行性病变合并骨质疏松的临床及影像学及并发症。

方法

回顾性分析2019 年1 月～ 2022 年3 月于空军军医大学第二附属医院治疗单节段腰椎退行性病变合并骨质疏松患者的临床资料，依据患者固定方式将患者随机分为CBT 固定组（n=48）与PS 固定组（n=53），CBT 组（66.20±8.45）岁，男性17 例，女性31 例，PS 组年龄（66.83±7.41）岁，男性18 例，女性35 例，平均随访时间（12.20±3.47）月。比较2 组患者VAS 评分、Oswestry 功能障碍指数（ODI）、手术时间、术中出血量、术后引流量、住院天数、影像学结果及并发症。

结果

2 组患者均顺利完成手术；CBT 组手术时间、术中出血量、切口长度、术后引流量均显著优于PS 组（P<0.05），2 组住院时间的差异均无统计学意义（P>0.05），腰痛及腿疼VAS 评分和ODI 指数均显著降低（P<0.05）。术后3 个月时CBT 组ODI 指数低于PS 组（P<0.05），末次随访时腰腿痛VAS 评分和ODI 指数差异无统计学意义（P>0.05）。末次随访时椎间融合率CBT 组为45/48（93.75%），传统组为48/53（90.57%），2 组间差异无统计学意义（P>0.05），螺钉松动率CBT 组优于PS 组（P<0.05）。

结论

腰椎退变性疾病合并骨质疏松行TLIF 融合术CBT 固定较PS 固定短期疗效更佳，CBT 组的腰椎稳定性显著更好，在骨质疏松患者TLIF 中CBT 螺钉固定是一种合理的固定。

Objective

To make a comparative analysis of the efficacy and complications of transforaminal lumbar interbody fusion (TLIF) with cortical bone trajectory (CBT) fixation versus pedicle screw (PS) fixation in the treatment of lumbar degenerative disease combined with osteoporosis.

Methods

Clinical data of patients with single-segment lumbar degenerative disease combined with osteoporosis treated in the Second Affiliated Hospital of the Air Force Medical University from January 2019 to March 2022 were retrospectively analyzed, and the patients were randomly divided into either a CBT fixation group (n=48) or a PS fixation group (n=53) based on the fixation method used. Patients in the CBT group had a mean age of (66.20±8.45) years old, with 37 male and 32 female cases, while those in the PS group had a mean age of (66.83±7.41) years old, with 36 males and 31 females. The mean followup time was (12.20±3.47) months. Visual analogue scale (VAS) score, Oswestry dysfunction index (ODI),operative time, intraoperative bleeding, postoperative drainage, hospitalization days, imaging findings,and complications were compared between the two groups of patients.

Results

Surgery was successfully completed in both groups. Operation time, intraoperative bleeding, incision length, and postoperative drainage were significantly better in the CBT group than in the PS group (P<0.05), but the difference in hospitalization time between the two groups was not statistically significant (P>0.05). Low back pain and leg pain VAS scores and ODI decreased significantly in both groups after surgery (P<0.05). ODI was lower in the CBT group than in the PS group at 3 months postoperatively (P<0.05), though the difference in low back and leg pain VAS scores and ODI at the final follow-up was not statistically significant (P>0.05). The proportion of patients with interbody fusion at the last follow-up was 45/48 (93.75%) in the CBT group and 49/53 (90.57%)in the PS group, and the difference between the two groups was not statistically significant (P>0.05). The screw loosening rate was better in the CBT group than in the PS group (P<0.05).

Conclusion

Improvement of clinical symptoms after single-segment lumbar TLIF fusion with CBT screw fixation in osteoporotic patients is comparable to that with PS fixation, and lumbar stability is significantly better in the CBT group,making CBT fixation a reasonable method in TLIF for osteoporotic patients.