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Title: [Comparison of Clinical Effects of Cortical Bone Trajectory Screws and Traditional Pedicle Screws in Posterior Lumbar Fusion].
Author: Zhang X, Gu Z, Zhang Y, Li G.
Journal: Sichuan Da Xue Xue Bao Yi Xue Ban; 2024 Mar 20; 55(2):303-308. PubMed ID: 38645868.
Abstract:
OBJECTIVE: To compare the clinical effects of cortical bone trajectory screws and traditional pedicle screws in posterior lumbar fusion. METHODS: A retrospective study was conducted to analyze lumbar degeneration patients who underwent surgical treatment at our hospital between January 2016 and January 2019. A total of 123 patients who met the inclusion criteria were enrolled. The subjects were divided into two groups according to their surgical procedures and the members of the two groups were matched by age, sex, and the number of fusion segments. There were 63 patients in the traditional pedicle screws (PS) group and 60 in the cortical bone trajectory screws (CBTS) group. The outcomes of the two groups were compared. The primary outcome measures were perioperative conditions, including operation duration, estimated intraoperative blood loss (EBL), and length-of-stay (LOS), visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, and interbody fusion rate. The secondary outcome measures were the time to postoperative ambulation and the incidence of complications. VAS scores and ODI scores were assessed before operation, 1 week, 1 month, 3 months, and 12 months after operation, and at the final follow-up. The interbody fusion rate was assessed in 1 year and 2 years after the operation and at the final follow-up. RESULTS: The CBTS group showed a reduction in operation duration ([142.8±13.1] min vs. [174.7±15.4] min, P<0.001), LOS ([9.5±1.5] d vs. [12.0±2.0] d, P<0.001), and EBL ([194.2±38.3] mL vs. [377.5±33.1] mL, P<0.001) in comparison with the PS group. The VAS score for back pain in the CBTS group was lower than that in the PS group at 1 week and 1 month after operation and the ODI score in the CBTS group was lower than that in the PS group at 1 month after operation, with the differences being statistically significant (P<0.05). At each postoperative time point, the VAS score for leg pain and the interbody fusion rate did not show significant difference between the two groups. The VAS score for back and leg pain and the ODI score at each time point after operation in both the CBTS group and the PS group were significantly lower than those before operation (P<0.05). No significant difference was found in the time to postoperative ambulation or the overall complication incidence between the two groups. CONCLUSION: The CBTS technique could significantly shorten the operation duration and LOS, reduce EBL, and achieve the same effect as the PS technique does in terms of intervertebral fusion rate, pain relief, functional improvement, and complication incidence in patients undergoing posterior lumbar fusion. 目的: 比较皮质骨轨迹螺钉和传统椎弓根螺钉在腰椎后路融合中的临床效果。方法: 回顾性分析本院2016年1月–2019年1月经过手术治疗的腰椎退变患者，符合入组条件的患者共123例，按不同术式分组，按照年龄、性别、融合节段数进行匹配，其中传统椎弓根螺钉（traditional pedicle screws, PS）组63例，皮质骨轨迹螺钉（cortical bone trajectory screws, CBTS）组60例。对两组的结局指标进行比较。主要结局指标为围术期情况（包括手术时间、术中估计失血量、住院时间）、视觉模拟量表（visual analog scale, VAS）评分、Oswestry功能障碍指数（Oswestry Disability Index, ODI）评分、椎体间融合率，次要结局指标为术后首次活动时间、并发症发生率。分别在术前和术后1周、1个月、3个月和12个月以及末次随访评估VAS评分和ODI评分。术后1年、2年和末次随访时评估椎体间融合率。结果: CBTS组与PS组相比较，手术时间〔（142.8±13.1） min vs.（174.7±15.4） min，P<0.001〕、住院时间〔（9.5±1.5） d vs.（12.0±2.0） d，P<0.001〕和术中估计失血量〔（194.2±38.3） mL vs.（377.5±33.1） mL，P<0.001〕均减少。两组间比较，术后1周和术后1个月CBTS组腰痛的VAS评分低于PS组，术后1个月CBTS组的ODI评分低于PS组，差异均有统计学意义（P<0.05）；术后各时点两组下肢痛的VAS评分、椎体间融合率之间的差异无统计学意义。各组内比较，相比于术前，CBTS组、PS组术后各时点的背痛VAS评分、下肢痛VAS评分、ODI评分均降低，差异均有统计学意义（P<0.05）。 CBTS组与PS组相比较，术后首次活动时间、总体并发症发生率差异无统计学意义。结论: 在腰椎后路融合手术中，CBTS技术在椎体间融合率、疼痛缓解、功能改善及并发症发生率等方面取得和PS技术同样效果，且能显著缩短手术时间和住院时间，减少失血量。

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