Delgado-Fernandez Juan, García-Pallero Maria Ángeles, Blasco Guillermo, Pulido-Rivas Paloma, Sola Rafael G
Division of Neurosurgery, Department of Surgery, University Hospital La Princesa, Madrid, Spain.
Asian Spine J. 2017 Oct;11(5):817-831. doi: 10.4184/asj.2017.11.5.817. Epub 2017 Oct 11.
This article summarizes recent evidence on the cortical bone trajectory (CBT) obtained from published anatomical, biomechanical, and clinical studies. CBT was proposed by Santoni in 2009 as a new trajectory that can improve the fixation of pedicle screws in response to screw loosening in osteoporotic patients. Recently, research interest has been growing with increasing numbers of published series and frequent reports of new applications. We performed an online database search using the terms "cortical bone trajectory," "pedicle screw," "CBT spine," "CBT fixation," "MISS CBT," and "traditional trajectory." The search included the PubMed, Ovid MEDLINE, Cochrane, and Google Scholar databases, resulting in an analysis of 42 articles in total. These covered three aspects of CBT research: anatomical studies, biomechanical parameters, and clinical cases or series. Compared to the traditional trajectory, CBT improves pullout strength, provides greater stiffness in cephalocaudal and mediolateral loading, and shows superior resistance to flexion/extension; however, it is inferior in lateral bending and axial rotation. CBT seems to provide better immediate implant stability. In clinical studies, CBT has shown better perioperative results for blood loss, length of stay in hospital, and surgery time; similar or better clinical postoperative scores; and similar comorbidity, without any major fixation system complications due to instrumentation failure or screw misplacement. In addition, advantages such as less lateral exposure allow it to be used as a minimally invasive technique. However, most of the clinical studies were retrospective case series or case-control studies; prospective evidence on this technique is scarce, making a definitive comparison with the traditional trajectory difficult. Nevertheless, we can conclude that CBT is a safe technique that offers good clinical results with similar biomechanical and perioperative parameters to those of the traditional trajectory. In addition, new applications can improve its results and make it useful for additional pathologies.
本文总结了近期从已发表的解剖学、生物力学和临床研究中获得的关于皮质骨轨迹（CBT）的证据。CBT由桑托尼于2009年提出，作为一种新的轨迹，可改善椎弓根螺钉在骨质疏松患者中因螺钉松动而导致的固定效果。最近，随着发表系列的增加和新应用的频繁报道，研究兴趣不断增长。我们使用“皮质骨轨迹”“椎弓根螺钉”“CBT脊柱”“CBT固定”“微创CBT”和“传统轨迹”等术语进行了在线数据库搜索。搜索包括PubMed、Ovid MEDLINE、Cochrane和谷歌学术数据库，总共分析了42篇文章。这些文章涵盖了CBT研究的三个方面：解剖学研究、生物力学参数以及临床病例或系列。与传统轨迹相比，CBT提高了拔出强度，在头尾向和内外侧加载时提供更大的刚度，并显示出对屈伸的卓越抵抗力；然而，在侧弯和轴向旋转方面较差。CBT似乎能提供更好的即时植入稳定性。在临床研究中，CBT在失血、住院时间和手术时间方面显示出更好的围手术期结果；临床术后评分相似或更好；合并症相似，且没有因器械故障或螺钉误置导致的任何主要固定系统并发症。此外，如更少的外侧暴露等优势使其可作为一种微创技术使用。然而，大多数临床研究是回顾性病例系列或病例对照研究；关于该技术的前瞻性证据很少，难以与传统轨迹进行明确比较。尽管如此，我们可以得出结论，CBT是一种安全的技术，与传统轨迹相比，在生物力学和围手术期参数相似的情况下能提供良好的临床结果。此外，新的应用可以改善其效果，并使其对其他病症有用。
