Objective: To compare the effectiveness of cortical bone trajectory screw (CBTS) and conventional pedicle screw for posterior lumbar interbody fusion (PLIF) in the treatment of single segment lumbar degenerative disease.
Methods: Between May 2013 and May 2016, a total of 97 patients with single segment lumbar degenerative disease were treated with PLIF. Fifty-one patients were fixed with CBTS in PLIF (trajectory screw group) and 46 with pedicle screw (pedicle screw group). There was no significant difference in age, gender, body mass index, preoperative diagnosis, lesion segment, and preoperative visual analogue scale (VAS) score, Oswestry dysfunction index (ODI) between 2 groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage, bed rest time, length of hospital stay, serum creatine kinase (CK) concentration, total amount of diclofenac sodium, perioperative complications, ODI, VAS score, and interbody fusion rate were recorded and compared between 2 groups.
Results: All patients were followed up 12 months. The patients in trajectory screw group had a significantly less operation time, intraoperative blood loss, postoperative drainage, and serum CK concentration when compared with the patients in pedicle screw group ( P<0.05). Thirty-five patients (68.6%) in trajectory screw group and 46 patients (100%) in pedicle screw group were given diclofenac sodium within 48 hours after operation, showing significant difference between 2 groups ( χ2=89.334, P=0.000). There was no significant difference in the incidence of perioperative complications between trajectory screw group and pedicle screw group (3.9% vs. 8.7%, P=0.418). There was no significant difference in the VAS score, ODI, and interbody fusion rate at 12 months after operation between 2 groups ( P>0.05).
Conclusion: For the single segment degenerative lumbar disease, the use of CBTS or conventional pedicle screw for PLIF can obtain satisfactory clinical function and interbody fusion rate. But the former has the advantages of less blood loss, less intraoperative muscle damage, less perioperative pain, shorter length of hospital stay and bed rest time.
目的: 比较皮质骨通道螺钉（cortical bone trajectory screw，CBTS）及椎弓根螺钉行腰椎后路椎间融合（posterior lumbar interbody fusion，PLIF）治疗单节段腰椎退变性疾病的疗效差异。.
方法: 回顾分析 2013 年 5 月—2016 年 5 月采用 PLIF 治疗的 97 例单节段腰椎退变性疾病患者临床资料。其中，51 例采用 CBTS 行 PLIF（通道螺钉组），46 例采用椎弓根螺钉行 PLIF（椎弓根螺钉组）。两组患者性别、年龄、体质量指数、病变类型、病变节段以及术前疼痛视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）比较，差异均无统计学意义（ P>0.05）。比较两组手术时间、术中失血量、术后引流量、术后卧床时间及住院时间，围手术期并发症发生率；检测术后血清肌酸激酶（creatine kinase，CK）浓度，评估肌肉损伤程度；术后 48 h 内使用镇痛药物情况；采用 VAS 评分评价腰痛情况，ODI 评价临床疗效，三维 CT 评价椎间融合。.
结果: 两组患者均获 12 个月随访。与椎弓根螺钉组相比，通道螺钉组手术时间、术后卧床时间及住院时间明显缩短，术中失血量及术后引流量显著减少，术后血清 CK 浓度较低，比较差异均有统计学意义（ P<0.05）。术后 48 h 内，通道螺钉组 35 例（68.6%）、椎弓根螺钉组 46 例（100%）给予镇痛药物，差异有统计学意义（ χ2=89.334， P=0.000）。通道螺钉组并发症发生率为 3.9%，与椎弓根螺钉组 8.7% 比较，差异无统计学意义（ P=0.418）。术后 12 个月两组 VAS 评分、ODI 以及椎间融合率比较，差异均无统计学意义（ P>0.05）。.
结论: 对于单节段腰椎退行性疾病，采用 CBTS 或椎弓根螺钉行 PLIF，均可获得满意临床疗效和椎间融合率，但前者具有术中出血量少、肌肉损伤小、患者围手术期痛苦小等优点。.
Keywords: Degenerative lumbar disease; cortical bone trajectory screw; pedicle screw; posterior lumbar interbody fusion.