探讨同一椎弓根内置入传统椎弓根螺钉和皮质骨通道螺钉的可行性*

目的探讨同一椎弓根内置入传统椎弓根螺钉和皮质骨通道螺钉的可行性，为腰椎相邻节段退变性疾病翻修及严重骨质疏松患者双螺钉固定提供参考依据。方法选择我院2015年10月至2017年10月期间住院的40例患者腰椎CT数据，其中男18例，女22例，年龄19～83岁，平均年龄（57.9±17.4）岁。通过数字化技术分别进行三维重建，根据腰椎不同节段椎弓根皮质骨通道参考宽度（trajectory reference width，TRW）、椎弓根宽度（pedicle width，PW）及椎弓根松质骨宽度（spongy bone width，SBW）来选择合适尺寸的椎弓根螺钉和皮质骨通道螺钉。本研究基于传统椎弓根螺钉置入皮质骨通道螺钉和同时置入传统椎弓根螺钉和皮质骨通道螺钉两种方式分别进行模拟置钉。置钉过程中如果出现不可避免的刺破通道皮质或置入的双螺钉间存在耦合部分均视为置钉失败，根据置钉情况分别统计出两种置钉方式的置钉成功率，并根据TRW分组了解各区间的置钉成功率情况。结果腰椎各节段椎弓根内基于传统椎弓根螺钉置入皮质骨通道（cortical bone trajectory，CBT）螺钉的置钉成功率为L1：47.50%，L2：62.50%，L3：57.50%，L4：70.00%，L5：47.50%，平均置钉成功率为57.00%。椎弓根内同时置入传统椎弓根螺钉和CBT螺钉的置钉成功率分别为L1：61.25%，L2：76.25%，L3：77.50%，L4：91.25%，L5：82.50%，平均置钉成功率为77.75%。同时置入传统椎弓根螺钉和皮质骨通道螺钉组的置钉成功率明显高于基于传统椎弓根螺钉置入皮质骨通道螺钉组；随着TRW的增加，两组的置钉成功率也逐渐提高。结论椎弓根内同时置入传统椎弓根螺钉和CBT螺钉的成功率明显大于基于传统椎弓根螺钉置入CBT螺钉组，术前测量TRW对同一椎弓根内双螺钉固定的安全可行性具有重要的指导意义。

英文摘要:

Objective To discuss the feasibility of the implantation of both traditional pedicle screw and cortical bone trajectory screw in one pedicle, to provide the reference for revision and severe osteoporosis patients who need double screw placement. Methods CT scan data of lumbar vertebrae of 40 patients to our hospital from October 2015 to October 2017 has been retrospectively reviewed，including 18 males and 22 females, aged from 19 to 83 years, with an average age of (57.9 ±17.4) years., segmentations and 3D reconstructions have been performed. Appropriate sized pedicle and cortical bone trajectory screws have been selected, based on the trajectory reference width (TRW), pedicle width (PW) and spongy bone width (SBW) of the respective segments of lumbar vertebrae. In this research, placement simultaneous of both PS and CBT screws have been simulated. Failure of placement have been defined by inevitable penetration of pedicle or screws overlapping , the success rate of placement has been calculated ,as well as inter-group success rate, and the groups were divided based on TRW. Results On lumbar vertebral segments, the success rate of placement of CBT screws with existing pedicle screws was L1: 47.50%, L2: 62.50%, L3: 57.50%, L4: 70.00%, L5: 47.50%. The average success rate of placement was 57.00%. The success placement rate of conventional pedicle screw and CBT screw in the pedicle was L1: 61.25%, L2: 76.25%, L3: 77.50%, L4: 91.25%, L5: 82.50%, and the average nail was placed. The success rate was 77.75%. The success rate of simultaneous placement of the traditional pedicle screw and cortical bone trajectory screw group was significantly higher than that of the traditional pedicle screw placement in the cortical bone channel screw group. The success rate of nailing is gradually increasing with the increase of TRW. Conclusion The success rate of simultaneous placing of traditional pedicle screw and CBT screw in one pedicle is significantly greater than that based on traditional pedicle screw. Into the CBT screw group, preoperative measurement of TRW has important guiding significance for the safety of double screw fixation in the same pedicle.

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