Lai Zhen, Shi Shi-Yuan, Fei Jun, Han Gui-He, Hu Sheng-Ping
Department of Orthopaedics, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou 310003, Zhejiang, China.
Zhongguo Gu Shang. 2020 Jul 25;33(7):636-42. doi: 10.12200/j.issn.1003-0034.2020.07.009.
To compare clinical effect of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in treating senile patients with lumbar tuberculosis.
From January 2014 to January 2017, 42 senile patients with lumbar tuberculosis were divided into CBT group and PS group, 21 patients in each group. In CBT group, there were 12 males and 9 females, aged from 64 to 81 years old with an average of (72.52±9.25) years old, T value of bone mineral density was (-2.69±0.17) g / cm, posterior CBT screw internal fixation and anterior debridement, interbody fusion with bone grafting was performed. In PS group, there were 11 males and 10 females, aged from 63 to 85 years old with an average of (71.42±9.81) years old, T value of bone mineral density was (-2.70±0.21) g / cm, PS internal fixation and anterior debridement, interbody fusion with bone grafting were performed. Length of posterior incision, intraoperative bleeding volume, operation time, time of bone graft fusion and complications between two groups were compared. Level of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), segment kyphotic Cobb angle before and after operation were compared, VAS score was used to evaluate pain releasing, JOA score was applied to evaluate clinical effect.
All patients were followed up from 12 to 21 months with an average of (15.00±3.57) months. No reoccurrence of lumbar tuberculosis and screw loosing occurred. There were statistical difference in length of incision, intraoperative bleeding volume, operation time between two groups (<0.05). Level ofESR and CRP between two groups at 2 weeks, 1 month and 6 months after operation were improved after operation, while there were no differences between two groups (>0.05). There were no statistical differences in complications, time of bone graft fusion and segment kyphotic Cobb angle at 1 week after operation between two groups (>0.05). There was difference in Cobb angle at 12 months after operation (<0.05). For VAS score, there were no difference between two groups before operation and 3 months after operation(>0.05), but VAS score at 3 months after operation were improved after operation between two groups (<0.05).For JOA score, there were no difference between two groups before operation, 3 and 12 months after operation, and JOA score at 3 and 12 months after operation were improved than that of before operation between two groups (<0.05).
Both of CBT screw internal fixation and PS screw internal fixation could achieve satisfying results for the treatment of elderly patients with lumbar tuberculosis. PSinternal fixation has a long fixation but great trauma. However, CBT screw internal fixation only needs to fix adjacent segments of the lesion to reduce the fixation range, which has advantages of less trauma and strong screw holding force.
比较皮质骨轨迹（CBT）螺钉与椎弓根螺钉（PS）内固定治疗老年腰椎结核患者的临床效果。
选取2014年1月至2017年1月收治的42例老年腰椎结核患者，分为CBT组和PS组，每组21例。CBT组男12例，女9例，年龄64～81岁，平均（72.52±9.25）岁，骨密度T值为（-2.69±0.17）g/cm，行后路CBT螺钉内固定及前路病灶清除、椎间植骨融合术。PS组男11例，女10例，年龄63～85岁，平均（71.42±9.81）岁，骨密度T值为（-2.70±0.21）g/cm，行PS内固定及前路病灶清除、椎间植骨融合术。比较两组患者的后正中切口长度、术中出血量、手术时间、植骨融合时间及并发症发生情况。比较两组患者术前及术后红细胞沉降率（ESR）、C反应蛋白（CRP）水平及节段后凸Cobb角，采用视觉模拟评分法（VAS）评估疼痛缓解情况，采用日本骨科学会（JOA）评分评估临床疗效。
所有患者均随访12～21个月，平均（15.00±3.57）个月。均未出现腰椎结核复发及螺钉松动情况。两组患者切口长度、术中出血量、手术时间比较，差异有统计学意义（P<0.05）。两组患者术后2周、1个月、6个月的ESR、CRP水平均较术前改善，但组间比较差异无统计学意义（P>0.05）。两组患者术后1周并发症、植骨融合时间及节段后凸Cobb角比较，差异无统计学意义（P>0.05）。术后12个月两组患者Cobb角比较，差异有统计学意义（P<0.05）。VAS评分：两组患者术前及术后3个月比较，差异无统计学意义（P>0.05），但两组患者术后3个月VAS评分均较术前改善，差异有统计学意义（P<0.05）。JOA评分：两组患者术前、术后3个月及12个月比较，差异无统计学意义（P>0.05），但两组患者术后3个月及12个月JOA评分均较术前改善，差异有统计学意义（P<0.05）。
CBT螺钉与PS螺钉内固定治疗老年腰椎结核均能取得满意疗效。PS内固定固定节段长，但创伤大；CBT螺钉内固定只需固定病变相邻节段，缩小了固定范围，具有创伤小、螺钉把持力强的优点。
