皮质骨轨迹螺钉固定技术在腰椎手术中的应用(1)
【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., http://www.100md.com(郑武 林院 黄少辉)
【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., http://www.100md.com(郑武 林院 黄少辉)