目的: 观察经椎弓根皮质骨通道（cortical bone trajectory,CBT）螺钉联合椎弓根钉治疗老年退行性腰椎管狭窄症的临床疗效。方法: 选择2020年3月—2023年3月在湖南师范大学附属湘东医院经保守治疗无效的老年退行性腰椎管狭窄症疾病患者40例,随机分为对照组（20例）和观察组（20例）,进行腰椎后路减压植骨内固定术治疗,其中对照组患者采用单纯椎弓根螺钉内固定方式,观察组患者采用CBT螺钉联合椎弓根螺钉内固定。观察两组患者术后恢复情况、手术时间、术中出血量、术后引流量和手术前后疼痛视觉模拟量表（visual analogue scale/score,VAS）评分、日本骨科协会评估治疗分数（Japanese orthopaedic association score,JOA）评分等。结果: 观察组患者手术时间、术中出血量和术后引流量均低于对照组。两组患者症状均得到改善,术后VAS评分低于术前,JOA评分高于术前。观察组患者术后1周的腰痛及下肢疼痛VAS评分低于对照组,但术后6月时,两组患者VAS评分比较无明显差异。两组患者术前、术后1周及术后6月时的JOA评分比较无明显差异。两组患者均未出现硬膜囊破裂、脑脊液漏、神经损伤、伤口感染等并发症。两组患者术后6月随访X线片均未见未见螺钉松动、脱落、塌陷等情况。结论: 应用CBT螺钉联合椎弓根螺钉技术进行腰椎内固定治疗老年老年退行性腰椎管狭窄症具有术区暴露范围小、出血量少、手术时间短、肌肉和软组织损伤小、螺钉把持力强等优势,早期疗效满意,具有一定的推广应用价值。
Abstract
Objective To observe the clinical effect of transpedicle cortical bone channel (CBT) screw combined with pedicle nail in the treatment of senile degenerative lumbar spinal stenosis. Methods A total of 40 elderly patients with degenerative lumbar spinal stenosis who failed to receive conservative treatment in Xiangdong Hospital Affiliated to Hunan Normal University from March 2020 to March 2023 were selected and randomly divided into control group (20 cases) and observation group (20 cases) to receive lumbar posterior decompression and bone grafting internal fixation treatment. The control group was treated with single pedicle screw internal fixation. Observation group was treated with CBT screw combined with pedicle screw. Postoperative recovery, operation time, intraoperative blood loss, postoperative drainage volume, VAS score before and after operation, JOA score and so on were observed in both groups. Results The operative time, intraoperative blood loss and postoperative drainage volume in observation group were lower than those in control group. Symptoms were improved in both groups, with VAS score lower after surgery and JOA score higher than before surgery. The VAS scores of lumbago and lower limb pain in the observation group were lower than those in the control group 1 week after surgery, but there was no significant difference in VAS scores between the two groups 6 months after surgery. There was no significant difference in JOA scores between the two groups before surgery, 1 week after surgery and 6 months after surgery. There were no complications such as dural sac rupture, cerebrospinal fluid leakage, nerve injury or wound infection in the two groups. No loosening, falling off or collapse of screws were observed on X-ray films in both groups at 6 months after operation. Conclusion CBT screw combined with pedicle screw technique for lumbar internal fixation in the treatment of senile degenerative lumbar spinal stenosis has the advantages of small exposure area, less blood loss, short operation time, little muscle and soft tissue damage, strong screw holding, etc. The early curative effect is satisfactory, and has certain popularization and application value.
关键词
皮质骨通道 /
腰椎管狭窄症 /
椎弓根螺钉 /
脊柱融合术 /
疗效分析
Key words
cortical bone channel /
lumbar spinal stenosis /
pedicle screw /
spinal fusion surgery /
efficacy analysis
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参考文献
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基金
湖南省教育厅课题“CBT螺钉联合椎弓根钉治疗老年退行性腰椎管狭窄症的疗效观察”（21C0003）
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