Clinical Application Of Cortical Bone Channel In Lumbar Pedicle Screw Fixation

Objective:To investigate the application effect of cortical bone channel lumbar pedicle screw internal fixation(CBT)in intervertebral foramen lumbar interbody fusion,and to provide practical experience for the treatment of lumbar degenerative diseases.Methods:Using the method of random sampling,80 patients with lumbar degenerative disease who were treated in the orthopedic department of our hospital from February 2018 to February 2019 were selected as the research objects.According to the principle of odd even number random grouping,the above 80 cases were randomly divided into observation group and control group,with 40 cases in each group.In the observation group(CBT group),the paravertebral muscles were separated under the periosteum on both sides of spinous process after median incision,and the junction of pedicle and lamina was exposed.The intersection point of the horizontal line 1 mm below the transverse process and the central vertical line of the upper articular process was determined as the needle feeding position,and the opening was made through a 2 mm diameter grinding drill bit.In the coronal position,8°to 10°of extroversion was performed along the inward direction.The open cone was placed at the sagittal head angle of 20°to 30°and the guide pin was inserted.After that,the screw with length of 30-35mm and diameter of 5.5mm was inserted through the X-ray fluoroscopy machine.After screw placement,decompression and fusion were started.In the control group(PS group),the paravertebral muscles were separated under the periosteum on both sides of spinous process.The method was the same as that in the observation group.Then,the lateral edge of the superior articular process was exposed,and then the"human"spine was determined as the needle entry point.At the coronal angle,the open cone(which should be parallel to the upper and lower endplates)was inserted at the sagittal inclination angle of 0°-30°,Once again,the screws with length of 35-45mm and diameter of 6.5-7.0mm were placed in the X-ray fluoroscopic machine.Then the operation was the same as the observation group.The operation duration,intraoperative blood loss,operative segment range,postoperative bed rest time,preoperative and postoperative hemoglobin levels were observed.ODI and VAS scores,postoperative fusion rate and complications of the two groups before and after1 week,3 months,6 months and 12 months were compared.Spss25.0 statistical software was used for analysis.Descriptive analysis and t-test were used to analyze the clinical efficacy and complications of different surgical methods.When p<0.05,the difference was statistically significant.Results:1.The operation time of L4/5,L5/S1 and 2-level(L4-S1)in the observation group were significantly lower than those in the control group(P<0.05);the operation time of 2-level(L4-S1)and L5/S1 and L4/5 segments in each group had statistical significance(P<0.05);2.The blood loss of L4/5,L5/S1 and 2-level(L4-S1)in the observation group were significantly less than those in the control group(P<0.05);the blood loss of 2-level(L4-S1)and L5/S1 and L4/5 segments in each group were significantly different(P<0.05);3.The hemoglobin reduction of the observation group at L4/5,L5/S1 and2-level(L4-S1)was significantly less than that of the control group,the difference was statistically significant(P<0.05);the hemoglobin reduction of2-level(L4-S1)and L5/S1 and L4/5 operation segments in each group was statistically significant(P<0.05);4.There was no significant difference between the observation group and the control group in the length of stay in bed and hospital stay at L4/5,L5/S1and 2-level(L4-S1)(P>0.05);5.The ODI and VAS scores of the observation group and the control group at 1 week,3 months,6 months and 1 year after operation were significantly higher than those before operation(P<0.05);there was no significant difference in ODI and VAS scores between the two groups at different time points(P>0.05);6.There was no significant difference in the fusion rate between the two groups(P>0.05).7.There was no significant difference in the incidence of complications between the observation group(17.50%)and the control group(22.50%)(χ~2=1.294,P>0.05).Conclusions:CBT and PS methods can significantly improve the clinical symptoms of patients with lumbar degenerative diseases,but CBT method has obvious advantages in blood loss control and screw holding force,can significantly shorten the operation time,the process of screw placement is safer,less damage to surrounding tissues,and is more suitable for patients with osteoporosis and osteopenia.