Application Of Cortical Bone Trajectory Screws In Lumbar Interbody Fusion And Internal Fixation

Objective To compare the clinical efficacy of cortical bone trajectory(CBT)fixation and traditional pedicle screw(PS)fixation in the treatment of lumbar degenerative diseases,and to explore the clinical application value of CBT screws fixation technique.Methods According to the inclusion and exclusion criteria,30 patients with lumbar degenerative disease who were treated in the spine orthopedics department of Hefei First People's Hospital from September 2017 to December 2018 were choosed.The patients were divided into two groups,of which 15 patients were treated with CBT screw fixation(CBT group)and 15 patients were treated with traditional PS fixation(PS group).All patients were treated with posterior lumbar interbody fusion and internal fixation.The operations were performed by the same group of doctors.There were 19 males and 11 females,aged 55 to 73,the average age was 62.8.Recorded the patients' gender,age,disease type,fixed segment,perioperative visual analogue scale(VAS),and perioperative Oswestry disability index(ODI)of the two groups.The operation time,intraoperative blood loss,postoperative drainage,postoperative bedtime,postoperative hospital stay,postoperative concentration of serum creatine kinase(CK)and operative complications were compared between the two groups.VAS and ODI scores at one week,three months,six months,and one year after operation were used to evaluate the clinical efficacy.Three-dimensional CT was used to evaluate the intervertebral fusion.Statistical software SPSS 17.0 was used for statistical analysis.The measurement data normally distributed of the two groups were compared using independent t-test,and the comparison of counting data was performed using chi-square test or Fisher exact test.Results There was no significant difference in patients' gender,age,disease type,fixed segment,perioperative VAS,and perioperative ODI scores between the two groups.Thirty surgeries were successfully completed,no vascular and nerve damage occurred during the placement of the screws,and there was no screw loosening,isthmus or pedicle damage.Postoperative symptoms of the patiens were alleviatied to different degrees.All patients were followed up for 12 months.There was no significant difference in the operation time between the CBT group and the PS group [[(165.3±37.8)min vs(161.0 ± 37.0)min,t = 0.312,P = 0.757].The intraoperative blood loss in the CBT group was lower than that in the PS group [(254.0 ± 88.2)ml vs(318.7 ± 70.4)ml,t =-2.219,P = 0.035],the postoperative drainage was lower than that in PS group[(156.8 ± 37.1)ml vs(217.0 ± 45.6)ml,t =-3.965,P = 0.000],the postoperative bedtime is shorter than that of the PS group [(3.7 ± 0.9)d vs(5.5 ± 1.1)d,t =-5.051,P= 0.000],and the postoperative hospital stay is shorter than that in PS group [(5.8 ± 1.7)d vs(8.9 ± 2.7)d,t =-3.875,P = 0.001],postoperative CK level was significantly lower in the CBT group than that in the PS group [(263.5 ± 42.5)U/L vs(396.5 ± 42.7)U/L,t=-8.553,P = 0.000],these differences were statistically significant(P <0.05).At one week after operation,the VAS score of the CBT group was significantly lower than that of the PS group(t =-2.472,P = 0.020),and the ODI scores difference was not statistically significant(t =-1.441,P = 0.161).At three months after operation,there was no statistically significant difference in VAS and ODI score between the two groups(t =-1.382,-0.346,P = 0.178,0.732);at six months after operation,the VAS score of CBT group was significantly lower than that of PS group,and ODI score was lower than that of PS group(t =-2.366,-5.876,P = 0.025,0.000);the VAS and ODI score of the CBT group were significantly lower than those of the PS group at one year after operation,and the differences were statistically significant(t =-2.233,-6.045,P =0.034,0.000).There was no significant difference in the incidence of complications such as wound infection,cage displacement,screw loosening,and fixation fracture between the two groups;there was no significant difference in interbody fusion rates between the two groups.Conclusion The CBT screw fixation technique can be used to treat lumbar degenerative diseases with satisfactory clinical effect.Compared with traditional pedicle screw fixation,CBT screw fixation has the advantages of shorter incision,shorter operation time,less operative blood loss,minimal surgical trauma,rapid postoperative recovery,less perioperative pain,and less backache.CBT screw fixation technique,as an improvement of traditional PS fixation technique,is a better minimally invasive surgical method.It has good clinical value and broad application prospects,and deserves further promotion.