[1]袁林,贾育松△,李亚锋,等.皮质骨轨迹椎弓根螺钉在腰椎后路融合术后邻椎病中的应用[J].中国中医骨伤科杂志,2023,31(04):25-30+35.[doi:10.20085/j.cnki.issn1005-0205.230405 ]
　YUAN Lin,JIA Yusong,LI Yafeng,et al.Application of Cortical Bone Trajectory Screws in Adjacent Segment Disease after Posterior Lumbar Interbody Fusion[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2023,31(04):25-30+35.[doi:10.20085/j.cnki.issn1005-0205.230405 ]
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皮质骨轨迹椎弓根螺钉在腰椎后路融合术后邻椎病中的应用()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第31卷
期数:
2023年04期
页码:
25-30+35
栏目:
临床研究
出版日期:
2023-04-15

文章信息/Info

Title:
Application of Cortical Bone Trajectory Screws in Adjacent Segment Disease after Posterior Lumbar Interbody Fusion
文章编号:
1005-0205(2023)04-0025-06
作者:
袁林1; 贾育松2△; 李亚锋1; 赵学千2; 刘楚吟2; 马慧1; 杨浩田1
1北京中医药大学第一临床医学院(北京,100700) 2清华大学第二附属医院骨科
Author(s):
YUAN Lin1; JIA Yusong2△; LI Yafeng1; ZHAO Xueqian2; LIU Chuyin2; MA Hui1; YANG Haotian1
1The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100700, China; 2Department of Orthopedics, Second Affiliated Hospital of Tsinghua University, Beijing 100040, China.
关键词:
腰椎;  皮质骨轨迹螺钉;  腰椎融合术;  邻椎病
Keywords:
lumbar spine;  cortical bone trajectory screw;  lumbar fusion;  adjacent segment disease
分类号:
R681.5
DOI:
10.20085/j.cnki.issn1005-0205.230405
文献标志码:
A
摘要:
目的:探讨皮质骨轨迹(CBT)椎弓根螺钉治疗腰椎后路融合术后邻椎病(ASD)的疗效和优势。方法:回顾性分析2017年9月至2021年7月应用皮质骨轨迹椎弓根螺钉治疗邻椎病23例患者临床资料。其中男7例,女16例; 年龄为58～81岁; 与初次手术间隔时间为1.7～10.0年。统计患者体重指数(BMI)、手术节段、手术时间、术中出血量、手术并发症等。通过影像学检查判断是否发生内固定松动、假关节形成和再次邻近节段退变。比较术前及末次随访时腰痛和腿痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评分,评估患者手术前后疼痛缓解和功能改善情况。结果:所有患者均顺利完成手术,手术时间为(210±38)min; 术中出血量平均为309 mL(300～400 mL)。2 例术后并发急性膀胱炎,给予抗感染后治愈。未出现螺钉松动及假关节形成等内固定相关并发症,未再次出现症状性邻近节段退变。术前患者腰痛VAS评分为(4.8±1.1)分,腿痛评分为(6.1±1.6)分,ODI 评分为50.6%±8.3%。末次随访患者腰痛VAS评分为(1.7±0.5)分,腿痛评分为(1.3±0.4)分,ODI 评分为13.5%±5.1%。所有患者随访时间平均为37个月(17～52个月),末次随访患者各指标评分均较术前明显改善,差异有统计学意义(P<0.01),总体临床效果满意。结论:皮质骨轨迹椎弓根螺钉应用于腰椎术后邻椎病,有损伤小、抗拔出力强的优势,可作为腰椎邻椎病手术方案。
Abstract:
Objective:To investigate the efficacy and advantages of the cortical bone trajectory(CBT)pedicle screw in the treatment of adjacent segment disease(ASD)after posterior lumbar fusion. Methods:The clinical data of 23 patients with ASD treated with CBT pedicle screw from September 2017 to July 2021 were retrospectively analyzed, including 7 males and 16 females, aged 58 to 81 years old, and the interval between the initial operation was 1.7 to 10.0 years. Body mass index(BMI), surgical segment, operation time, intraoperative blood loss, and surgical complications were counted. The occurrence of internal fixation loosening, pseudoarthrosis to ASD was determined by imaging examination. The visual analog scale(VAS)and Oswestry disability index(ODI)scores for low back and leg pain were compared before and at the last follow-up to evaluate the pain relief and functional improvement of the patients before and after surgery. Results:All 23 cases were completed, the operation time was(210±38)min, and the intraoperative blood loss was 309 mL(300 to 400 mL). One case of postoperative acute cystitis was cured after antibiotic treatment. There were no internal fixation-related complications such as screw loosening and pseudoarthrosis, and no symptomatic adjacent segment degeneration occurred again. Before surgery, the low back pain VAS score was(4.8±1.1)points, the leg pain VAS score was(6.1±1.6)points, and the ODI score was 50.6%±8.3%. At the last follow-up, the low back pain VAS score was(1.7±0.5)points, the leg pain VAS score was(1.3±0.4)points, and the ODI score was 13.5%±5.1%. All patients were followed up for 37 months(17 to 52 months). The scores of each index in the last follow-up were significantly improved compared with those before the operation, and the differences were statistically significant(P<0.01). The overall clinical effect was satisfactory. Conclusion:The cortical bone trajectory pedicle screw has the advantages of less damage and strong pullout resistance in adjacent spondylosis after lumbar surgery and can be used as a revision surgery plan for lumbar ASD.

参考文献/References:

[1] BAGHERI S R,ALIMOHAMMADI E,ZAMANI F A,et al.Adjacent segment disease after posterior lumbar instrumentation surgery for degenerative disease:Incidence and risk factors[J].J Orthop Surg(Hong Kong),2019,27(2):615502666.
[2] MESREGAH M K,YOSHIDA B,LASHKARI N,et al.Demographic,clinical,and operative risk factors associated with postoperative adjacent segment disease in patients undergoinglumbar spine fusions:a systematic review and meta-analysis[J].Spine J,2022,22(6):1038-1069.
[3] ZHANG C,BERVEN S H,FORTIN M,et al.Adjacent segment degeneration versus disease after lumbar spine fusion for degenerative pathology:a systematic review with meta-analysis of the literature[J].Clin Spine Surg,2016,29(1):21-29.
[4] NOH S H,ZHANG H Y.Minimally invasive spine surgery with midline cortical bone trajectory screw fixation for lumbar degenerative disease in a retrospective study of 200 patients[J].Neurospine,2021,18(2):355-362.
[5] 潘爱星,刘玉增,海涌,等.皮质骨轨迹螺钉及骶骨翼螺钉内固定在腰椎邻近节段退变疾病中的应用研究[J].中华医学杂志,2022,102(17):1297-1302.
[6] HASHIMOTO K,AIZAWA T,KANNO H,et al.Adjacent segment degeneration after fusion spinal surgery-a systematic review[J].Int Orthop,2019,43(4):987-993.
[7] WANG J C,ARNOLD P M,HERMSMEYER J T,et al.Do lumbar motion preserving devices reduce the risk of adjacent segment pathology compared with fusion surgery? A systematic review[J].Spine(Phila Pa 1976),2012,37(22 Suppl):S133-S143.
[8] 陈新用,梁裕,曹鹏,等.手术治疗腰椎间盘突出症的长期疗效及其影响因素[J].中国脊柱脊髓杂志,2012,22(8):717-721.
[9] OU C Y,LEE T C,LEE T H,et al.Impact of body mass index on adjacent segment disease after lumbar fusion for degenerative spine disease[J].Neurosurgery,2015,76(4):396-401.
[10] WANG T,DING W.Risk factors for adjacent segment degeneration after posterior lumbar fusion surgery in treatment for degenerative lumbar disorders:a meta-analysis[J].J Orthop Surg Res,2020,15(1):582.
[11] MARAGKOS G A,ATESOK K,PAPAVASSILIOU E.Prognostic factors for adjacent segment disease after L4-L5 lumbar fusion[J].Neurosurgery,2020,86(6):835-842.
[12] COLO G,CAVAGNARO L,ALESSIO-MAZZOLA M,et al.Incidence,diagnosis and management of sacroiliitis after spinal surgery:a systematic review of the literature[J].Musculoskelet Surg,2020,104(2):111-123.
[13] IVANOV A A,KIAPOUR A,EBRAHEIM N A,et al.Lumbar fusion leads to increases in angular motion and stress across sacroiliac joint:a finite element study[J].Spine(Phila Pa1976),2009,34(5):E162-E169.
[14] MOSHIRFAR A,JENIS L G,SPECTOR L R,et al.Computed tomography evaluation of superior-segment facet-joint violation after pedicle instrumentation of the lumbar spine with a midline surgical approach[J].Spine(Phila Pa 1976),2006,31(22):2624-2629.
[15] ZHONG Z M,DEVIREN V,TAY B,et al.Adjacent segment disease after instrumented fusion for adult lumbar spondylolisthesis:incidence and risk factors[J].Clin Neurol Neurosurg,2017,156:29-34.
[16] MARAGKOS GA,MOTIEI-LANGROUDI R,FILIPPIDIS A S,et al.Factors predictive of adjacent segment disease after lumbar spinal fusion[J].World Neurosurg,2020,133:e690-e694.
[17] 汪文龙,刘正,吴四军.腰椎 Topping-off 术式的临床应用及相关研究进展[J].中国骨与关节杂志,2019,8(2):136-140.
[18] OKUDA S,YAMASHITA T,MATSUMOTO T,et al.Adjacent segment disease after posterior lumbar interbody fusion:a case series of 1 000 patients[J].Global Spine J,2018,8(7):722-727.
[19] 柳万国,张静哲,赵贺.腰椎手术发生硬膜囊撕裂的危险因素及其预防进展[J].中国骨与关节损伤杂志,2016,31(7):4.
[20] SANTONI B G,HYNES R A,MCGILVRAY K C,et al.Cortical bone trajectory for lumbar pedicle screws[J].Spine J,2009,9(5):366-373.
[21] 申才良,章仁杰.腰椎皮质骨轨迹螺钉技术的应用拓展及相关问题[J].中华医学杂志,2021,101(45):3695-3699.
[22] DING H,HAI Y,LIU Y,et al.Cortical trajectory fixation versus traditional pedicle-screw fixation in the treatment of lumbar degenerative patients with osteoporosis:a prospective randomized controlled trial[J].Clin Interv Aging,2022,17:175-184.
[23] KIM S J,MOBBS R J,NATARAJAN P,et al.Historical note:the evolution of cortical bone trajectory and associated techniques[J].Spine Surg Relat Res,2022,6(1):1-9.
[24] 中国康复医学会脊柱脊髓专业委员会腰椎研究学组.腰椎后路经皮质骨轨迹螺钉内固定技术应用中国专家共识[J].中华医学杂志,2022,102(13):908-913.
[25] ZHANG L,LI H M,ZHANG R,et al.Biomechanical changes of adjacent and fixed segments through cortical bone trajectory screw fixation versus traditional trajectoryscrew fixation in the lumbar spine:a finite element analysis[J].World Neurosurg,2021,151:e447-e456.
[26] ZHANG R J,ZHOU L P,ZHANG L,et al.The rates and risk factors of intra-pedicular accuracy and proximal facet joint violation for single-level degenerative lumbar diseases:cortical bone trajectory versus traditional trajectory pedicle screw[J].Spine(Phila Pa 1976),2021,46(23):E1274-E1282.
[27] WANG J,HE X,SUN T.Comparative clinical efficacy and safety of cortical bone trajectory screw fixation and traditional pedicle screw fixation in posterior lumbar fusion:a systematic review and meta-analysis[J].Eur Spine J,2019,28(7):1678-1689.
[28] WU F L,DANG L,ZHOU H,et al.Two-year outcomes of midline lumbar fusion versus minimally invasive transforaminal lumbar interbody fusion in the treatment of L4-L5 degenerative disease[J].Biomed Environ Sci,2020,33(11):839-848.
[29] SAMAL F,STERBA A,HANINEC P,et al.Long-term outcome after midline lumbar fusion for the treatment of lumbar spine instability due to degenerative disease[J].World Neurosurg,2021,154:e641-e648.
[30] 李杰,陈意磊,陈斌辉,等.皮质骨轨迹螺钉在腰椎后路融合术后邻椎病中的应用及疗效分析[J].中华医学杂志,2021,101(45):3724-3729.
[31] HE K,DONG C,WEI H,et al.A minimally invasive technique using cortical bone trajectory screws assisted by 3d-printed navigation templates in lumbar adjacent segment degeneration[J].Clin Interv Aging,2021,16:1403-1413.
[32] 陈豪杰,刘世长,张嘉男,等.徒手与机器人辅助皮质骨轨迹螺钉固定治疗合并骨质疏松症的腰椎退行性疾病对比研究[J].中国修复重建外科杂志,2020,34(9):1142-1148.
[33] LI Y,CHEN L,LIU Y,et al.Accuracy and safety of robot-assisted cortical bone trajectory screw placement:a comparison of robot-assisted technique with fluoroscopy-assisted approach[J].BMC Musculoskelet Disord,2022,23(1):328.

备注/Memo

备注/Memo:
△通信作者 E-mail:jiayusong1970@163.com
更新日期/Last Update: 2023-04-10