Health Management Center, The Second Hospital of Shandong University, Shandong, People's Republic of China.
Department of Orthopedics, The Fourth People's Hospital, Heze, Shandong, People's Republic of China.
Orthop Surg. 2023 Jun;15(6):1617-1626. doi: 10.1111/os.13752. Epub 2023 May 18.
The mainstream lumbar fusion surgeries have various shortcomings, such as complex operation, much invasion, and loss of lumbar function. How to minimize the surgical injury and to achieve better therapeutic effects has become the goal pursued by spine surgeons. This study introduces a cortical bone trajectory (CBT) screw fixation combined with facet fusion (FF), evaluates its safety and efficacy, and explores its advantages, in order to provide a reference for treatment of patients with single-level lumbar stenosis or grade I degenerative spondylolisthesis.
We retrospectively analyzed the clinical, radiological, and operative data of 167 patients with single-level lumbar stenosis or grade I degenerative spondylolisthesis who underwent FF or transforaminal lumbar interbody fusion (TLIF) from January 2013 to September 2019 in the spine surgery department of the Second Hospital of Shandong University. Patients were divided into four groups according to surgical method: group CBT-FF, CBT screw combined with FF; group PS-FF, pedicle screw (PS) combined with FF; group CBT-TLIF, CBT screw combined with TLIF; and group PS-TLIF, PS combined with TLIF. The operation time, estimated intraoperative blood loss, complications after surgery, visual analog scale (VAS), and Oswestry disability index (ODI) of the four groups were compared. The fusion was evaluated by anteroposterior and lateral X-ray, CT scan, and three-dimensional reconstruction.
Twelve months after surgery, the fusion rate of four groups had no significantly statistical differences (p = 0.914). VAS and ODI scores were lower after surgery than before. Low back pain VAS scores 1 week after surgery in group CBT-FF and group CBT-TLIF were significantly lower than those in group PS-FF and group PS-TLIF (p = 0.001, p = 0.000, p = 0.049, p = 0.000). Low back pain VAS score 3 months after surgery was significantly lower in group CBT-FF than group PS-FF and group PS-TLIF (p = 0.045, p = 0.008). ODI score 1 week after surgery was significantly lower in group CBT-FF than group PS-FF, group CBT-TLIF, and group PS-TLIF (p = 0.000, p = 0.005, p = 0.000, p = 0.015). ODI score 3 months after surgery was significantly lower in group CBT-FF than group PS-FF, group CBT-TLIF, and group PS-TLIF (p = 0.001, p = 0.002, p = 0.000). Incidence of complications did not significantly differ among the groups.
CBT screw fixation combined with FF is a safe and efficacious procedure for patients with single-level lumbar stenosis or grade I degenerative spondylolisthesis. This minimally invasive approach of lumbar fusion can be simply and easily performed. Patients who undergo CBT screw fixation combined with FF recovered faster than TLIF.
主流腰椎融合术存在操作复杂、创伤大、腰椎功能丧失等诸多缺点。如何将手术损伤最小化，达到更好的治疗效果，成为脊柱外科医生追求的目标。本研究介绍一种皮质骨轨迹（CBT）螺钉固定联合小关节融合（FF）技术，评估其安全性和有效性，并探讨其优势，以期为单节段腰椎管狭窄症或 I 度退变性腰椎滑脱症患者的治疗提供参考。
回顾性分析 2013 年 1 月至 2019 年 9 月在山东大学第二医院脊柱外科行 FF 或经椎间孔腰椎体间融合术（TLIF）的 167 例单节段腰椎管狭窄症或 I 度退变性腰椎滑脱症患者的临床、影像学和手术资料。根据手术方法将患者分为 4 组：CBT-FF 组，CBT 螺钉联合 FF；PS-FF 组，PS 联合 FF；CBT-TLIF 组，CBT 螺钉联合 TLIF；PS-TLIF 组，PS 联合 TLIF。比较 4 组患者的手术时间、估计术中出血量、术后并发症、视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）。采用前后位、侧位 X 线片、CT 扫描和三维重建评估融合情况。
术后 12 个月，4 组融合率无统计学差异（p=0.914）。术后 VAS 和 ODI 评分均低于术前。CBT-FF 组和 CBT-TLIF 组术后 1 周腰痛 VAS 评分明显低于 PS-FF 组和 PS-TLIF 组（p=0.001、p=0.000、p=0.049、p=0.000）。CBT-FF 组术后 3 个月腰痛 VAS 评分明显低于 PS-FF 组和 PS-TLIF 组（p=0.045、p=0.008）。CBT-FF 组术后 1 周腰痛 ODI 评分明显低于 PS-FF 组、CBT-TLIF 组和 PS-TLIF 组（p=0.000、p=0.005、p=0.000、p=0.015）。CBT-FF 组术后 3 个月腰痛 ODI 评分明显低于 PS-FF 组、CBT-TLIF 组和 PS-TLIF 组（p=0.001、p=0.002、p=0.000）。各组并发症发生率无统计学差异。
CBT 螺钉固定联合 FF 治疗单节段腰椎管狭窄症或 I 度退变性腰椎滑脱症是一种安全有效的方法。这种微创腰椎融合术操作简单、易于实施。与 TLIF 相比，CBT 螺钉固定联合 FF 治疗的患者恢复更快。
