【摘要】 目的比较经椎间孔入路腰椎椎间融合术(transforaminal lumbar interbody fusion, TLIF)中应用皮质骨钉道螺钉(cortical bone trajectory screws, CBT)固定与传统椎弓根螺钉(pedicle screws, PS)固定的临床疗效。方法回顾性分析2014年1月～2016年12月在我科行TLIF术治疗的100例单节段腰椎退行性疾病患者的临床资料,其中行CBT螺钉固定组50例,PS螺钉固定组50例。所有患者术后随访12个月,比较两组切口长度、术中出血量、手术时间、术后3月下肢痛及腰痛视觉模拟评分(VAS)及术后1年Oswestry功能评分,术后12月行腰椎融合节段三维CT检查评估融合率。结果两组均顺利完成手术,均无严重并发症发生。与PS螺钉组比较,CBT螺钉组切口更小、术中失血量更少,差异均有统计学意义(P<0.05),而两组手术时间比较无统计学差异(P>0.05)。末次随访时两组患者均获得骨性融合。术后3月两组下肢痛、腰痛VAS评分以及术后1年Oswestry功能障碍指数评分均较术前明显改善(P<0.05),但两组间VAS评分、 Oswestry功能障碍指数评分比较无统计学差异(P>0.05)。结论 TLIF术中采用腰椎全皮质骨钉道椎弓根螺钉内固定能取得满意的临床效果,且出血少、椎旁肌损伤小,是腰椎内固定手术的一种良好选择。更多还原

【Abstract】 Objective To compare the effect of internal fixation between cortical bone trajectory(CBT) screws and conventional pedicle screws(PS) during the surgery of transforaminal lumbar interbody fusion(TLIF). Methods The clinical data of 100 cases with single segment lumbar degenerative diseases from January 2014 to December 2016 performed TLIF were analyzed retrospectively. Fifty patients underwent the CBT internal fixation as the CBT group, and 50 cases underwent the conventional PS internal fixation as the PS group. All cases were followed up for 12 months. The length of incision, intra-operative blood loss, operation time, visual analog scale(VAS) of 3 months after the surgery, the Oswestry index of 1 year after the surgery and lumbar fusion rate of 12 months after the surgery were compared between the two groups. ResultsAll cases were accomplished the surgery successfully without serious complication. Compare to the PS group, the length of incision was shorter and the intra-operative blood loss volume was less in the CBT group(P<0.05), but there was no statistical difference in the operation time between the two groups(P>0.05). The lumbar fusion was achieved in both two groups at the last follow-up. The VAS of lower limb and low back of 3 months after the surgery and the Oswestry index of 1 year after the surgery were improved obviously than those before the surgery(P<0.05), but no statistical differences were found between the two groups(P>0.05). Conclusion The internal fixation of CBT can achieve a reliable and satisfied result with less blood loss and mini-injuries of paravertebral muscles during TLIF, and which is a good choice for lumbar internal fixation.更多还原