Comparison of cortical bone trajectory screws and traditional trajectory screws in treatment of lumber degenerative patients with osteoporosis: a retrospective analysis
Liu Zhengpei, Kou Hongwei, Shang Guowei, Ji Yanhui, Chen Xiangrong, Sun Xinzhi, Bao Deming, Cheng Tian, Guo Junjie, Shang Chunfeng, Yan Miaoheng, Geng Zhihua, Zhu Di, Zhao Zhe, Wang Yisheng, Liu Hongjian
Department of Orthopaedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
Abstract:Objective To investigate and compare the clinical outcome of cortical bone trajectory (CBT) screws and traditional trajectory (TT) screws in treatment of single segment lumber degenerative patients with osteoporosis but without scoliosis or spondylolisthesis above degree I.Methods From February 2017 to February 2019, a retrospective analysis was made of 52 female patients who underwent L3/4 or L4/5 lumbar fusion with CBT screws or TT screws, aged 40-71 years, and accompanied by osteopenia or osteoporosis and without spondylolisthesis or scoliosis above grade I. Among them, 22 received CBT screw operation (CBT group) and 30 received TT screw operation (TT group). The operation time, intraoperative blood loss, surgical incision length and surgical complications were compared between the two groups.On the 5th day after operation, lumbar spine X-rays and CT scans were used to observe the fusion device, internal fixation position, and the incidence of proximal articular process joint infiltration (FJV). At 3, 6, 12, and 24 months after surgery, the lumbar spine X-ray film was reviewed to evaluate bone graft fusion and internal fixation.The Oswestry dysfunction index (ODI) and pain visual analogue score (VAS) were compared between the two groups of patients before surgery and the last follow-up.Results The operative time of CBT group and TT group was (125.7±16.0) min and (123.8±18.3) min respectively, the difference was not statistically significant (t=0.389, P>0.05); the intraoperative blood loss of CBT group was (74±39.8) mL, less than that of TT group (129±45.3) mL, and the incision length of CBT group was (5.7±0.60) cm, shorter than that of TT group (8.4±0.92) cm, the difference was statistically significant (t=4.548, 12.004, all P values < 0.05). Because of the poor fixation strength, one case in TT group ended up in using bone cement augmented pedicle screw in L4.The remaining patients did not experience nail placement failure or cortical bone fracture fractures during surgical nail placement.No vascular or nerve damage was found in any patient. X-ray and CT scan of the lumbar spine were taken on the 5th day after operation, showing that the fusion cage and internal fixation were in good position; the incidence of FJV in CBT group was 9.09% (4/44), and was 58.33% (35/60) in TT group, the difference was statistically significant (χ2=26.263, P<0.01). The symptoms of all patients were relieved after operation. The ODI and VAS scores of the last follow-up decreased significantly. There were no significant differences between two groups in VAS and ODI(all P values>0.05). The follow-up period was 5 to 24 months. The symptoms of all patients were relieved. Compared with that before operation, the scores of ODI and VAS in the last follow-up were lower, the difference was statistically significant (t=16.549, 18.490, all P values<0.01), but there was no significant difference between the two groups (all P values>0.05). No screw looseness, detachment or cutting was found, and the screw, connecting rod and fuser were all in good position.Conclusions Compared with TT screw, CBT screw has the same short-term effect in the treatment of single segment lumbar degenerative disease with osteopenia or osteoporosis but without scoliosis or spondylolisthesis above degree I. Moreover, CBT screw has better fixation strength and is more minimally invasive, which is worthy of clinical application.
刘正沛, 寇红伟, 尚国伟, 姬彦辉, 陈向荣, 孙新志, 包德明, 程田, 郭俊杰, 尚春风, 燕淼恒, 耿志华, 朱迪, 赵哲, 王义生, 刘宏建. 皮质骨轨道螺钉与常规椎弓根螺钉治疗合并骨质疏松的腰椎退行性疾病的对比研究[J]. 中华解剖与临床杂志, 2020, 25(3): 278-284.
Liu Zhengpei, Kou Hongwei, Shang Guowei, Ji Yanhui, Chen Xiangrong, Sun Xinzhi, Bao Deming, Cheng Tian, Guo Junjie, Shang Chunfeng, Yan Miaoheng, Geng Zhihua, Zhu Di, Zhao Zhe, Wang Yisheng, Liu Hongjian. Comparison of cortical bone trajectory screws and traditional trajectory screws in treatment of lumber degenerative patients with osteoporosis: a retrospective analysis. Chinese Journal of Anatomy and Clinics, 2020, 25(3): 278-284.
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