Department of Orthopedic, Fujian Provincial Hospital, Fuzhou, China.
Orthop Surg. 2023 May;15(5):1281-1288. doi: 10.1111/os.13704. Epub 2023 Apr 18.
Although cortical bone trajectory (CBT) screw fixation has been used for several years, the number of studies on its fusion effects is limited. Furthermore, several studies report conflicting outcomes. We aimed to compare the fusion rates and clinical efficacy of CBT screw fixation and pedicle screw (PS) fixation for L4-L5 interbody fusion.
This study was a retrospective cohort control study. Patients with lumbar degenerative disease who underwent L4-L5 oblique lumbar interbody fusion (OLIF) or posterior decompression using CBT screws between February 2016 and February 2019 were included. Patients in whom PS was used were matched for age, sex, height, weight, and BMI. Record the operation time, blood loss. All enrolled patients underwent lumbar CT imaging at one-year follow-up to evaluate the fusion rate. At the two-year follow-up the visual analogue scale (VAS), Oswestry disability index (ODI), and Japanese Orthopaedic Association scores (JOA) were used to identify symptom improvement. Independent t-test was used for the comparison, and score data were analyzed using the χ and exact probability tests.
A total of 144 patients with were included. All patients were followed-up postoperatively for 25-36 months (average 32.42 ± 10.55 months). Twenty-eight patients underwent OLIF and CBT screw fixation, 36 underwent OLIF and PS fixation, 32 underwent posterior decompression and CBT screw fixation, and 48 underwent posterior decompression and PS fixation. The fusion rates following CBT screw and PS fixations in OLIF were 92.86% (26/28) and 91.67% (33/36), respectively (P = 1). The fusion rates following CBT screw and PS fixations in posterior decompression were 93.75% (30/32) and 93.75% (45/48), respectively (P > 0.05). Regardless of OLIF or posterior decompression, there were no significant differences in the VAS, ODI, and JOA scores between patients treated with CBT and PS (P > 0.05).
CBT screw fixation can achieve a satisfactory interbody fusion rate with a clinical efficacy similar to that of PS in patients with lumbar degenerative disease, regardless of whether OLIF or posterior decompression was performed.
皮质骨轨迹（CBT）螺钉固定已应用多年，但关于其融合效果的研究数量有限。此外，一些研究报告的结果相互矛盾。我们旨在比较 CBT 螺钉固定和经皮椎弓根螺钉（PS）固定用于 L4-L5 椎间融合的融合率和临床疗效。
本研究为回顾性队列对照研究。纳入 2016 年 2 月至 2019 年 2 月间接受 L4-L5 斜侧腰椎椎间融合术（OLIF）或后路减压的采用 CBT 螺钉的腰椎退行性疾病患者。PS 组患者的年龄、性别、身高、体重和 BMI 相匹配。记录手术时间和失血量。所有入组患者在术后 1 年行腰椎 CT 影像学检查，以评估融合率。在术后 2 年随访时，采用视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）和日本骨科协会评分（JOA）评估症状改善情况。采用独立 t 检验进行比较，评分数据采用 χ²和确切概率检验进行分析。
共纳入 144 例患者。所有患者术后随访 25-36 个月（平均 32.42±10.55 个月）。28 例行 OLIF 和 CBT 螺钉固定，36 例行 OLIF 和 PS 固定，32 例行后路减压和 CBT 螺钉固定，48 例行后路减压和 PS 固定。OLIF 中 CBT 螺钉和 PS 固定的融合率分别为 92.86%（26/28）和 91.67%（33/36）（P=1）。后路减压中 CBT 螺钉和 PS 固定的融合率分别为 93.75%（30/32）和 93.75%（45/48）（P>0.05）。无论行 OLIF 还是后路减压，CBT 与 PS 治疗的患者在 VAS、ODI 和 JOA 评分方面均无显著差异（P>0.05）。
无论行 OLIF 还是后路减压，对于腰椎退行性疾病患者，CBT 螺钉固定均可获得满意的椎间融合率，其临床疗效与 PS 相似。
