王含,王晋超,田伟
WANG Han,WANG Jinchao,TIAN Wei

• 1:北京积水潭医院脊柱外科

摘要(Abstract)：

目的:探讨皮质骨轨迹(CBT)螺钉椎间融合术治疗骨质疏松并腰椎滑脱患者的临床效果。方法:选取骨质疏松并腰椎滑脱患者82例,分为观察组(CBT螺钉椎间融合术治疗)和对照组[传统的椎弓根(PS)螺钉椎间融合术治疗],术后随访10～34个月,采用双能X线吸收测量法测定腰椎骨密度(BMD)、结合临床症状改善情况综合评价治疗效果,比较2处手术方式的手术时间、术中出血量、术后植骨融合率及并发症;于术前、术后1个月及末次随访时,分别采用视觉模拟(VAS)评分评价2组患者的腰背疼痛症状,用日本矫形外科学会(JOA)评分评价功能恢复情况,影像学检查比较伤椎前缘高度比和伤椎后凸Cobb角。结果:观察组患者治疗总有效率高于对照组,并发症发生率低于对照组(P <0. 05);观察组患者术中出血量均值少于对照组,术后植骨融合率均值高于对照组(P <0. 05);与术前比较,术后1个月及末次随访时2组患者VAS评分、后凸Cobb角降低,JOA评分、椎前缘高度比提高(P <0. 05)。结论:与传统的PS螺钉椎间融合术相比,CBT螺钉椎间融合术治疗骨质疏松并腰椎滑脱患者,可有效改善骨密度、促进功能恢复及缓解疼痛症状。
Objective: To investigate the clinical effect of cortical bone trajectory( CBT) screw intervertebral fusion in treatment of osteoporosis with spondylolysis. Methods: 82 patients with osteoporosis and spondylolysis were divided into observation group( CBT screw intervertebral fusion treatment) and control group( traditional pedicle screw [PS] intervertebral fusion]. They were followed up for 10-34 months after surgery. The dual-energy X-ray absorptiometry( DXA) was used to determine changes in lumbar BMD,and therapeutic effects in both groups were comprehensively evaluated in combination with the improvement of clinical symptoms: operation time,intraoperative blood loss,postoperative bone graft fusion rate and occurrence of complications. The visual analogue scale( VAS) was used to evaluate lumbar and back pain before surgery,1 month after surgery and the last follow-up. The Japanese Orthopedic Association( JOA) score was used to evaluate functional recovery. The fractured vertebral height ratio and kyphosis Cobb angle were measured by medical imaging tests. Results: The total response rate in observation group was higher than that in control group,and the incidence of complications was lower than control group( P < 0. 05). The intraoperative blood loss of observation group was less than control group,and the postoperative bone graft fusion rate was higher than control group( P < 0. 05). Before surgery,1 month after surgery and at the last follow-up,VAS scores and kyphosis Cobb angles of injured vertebral bodies in both groups were decreased,while JOA scores and fracture vertebral height ratios were significantly increased( P <0. 05). Conclusion: Compared with traditional PS intervertebral fusion,CBT screw intervertebral fusion can effectively improve bone density,promote function recovery and relieve pain in treat patients with osteoporosis with lumbar spondylolysis.

关键词(KeyWords)： 骨质疏松;治疗结果;皮质骨轨迹;椎弓根螺钉;椎间融合术;腰椎滑脱
osteoporosis;treatment outcome;cortical bone trajectory;pedicle screw;intervertebral fusion;lumbar spondylolysis

Abstract:

Keywords:

基金项目(Foundation): 北京市自然科学基金项目(Z170001)

作者(Author): 王含,王晋超,田伟
WANG Han,WANG Jinchao,TIAN Wei

DOI: 10.19367/j.cnki.2096-8388.2020.09.019

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