目的观察在腰椎后路减压植骨内固定术治疗老年骨质疏松腰椎退变性疾病中应用皮质骨轨迹(CBT)螺钉联合椎弓根螺钉技术进行内固定操作的临床疗效。方法选择2014年2月至2015年4月在第二军医大学长征医院经保守治疗无效的骨质疏松腰椎退变性疾病患者32例进行腰椎后路减压植骨内固定术治疗,其中20例采用单纯椎弓根螺钉内固定方式(A组),12例采用CBT螺钉联合椎弓根螺钉内固定(B组)。观察两组患者术后恢复情况、手术时间、术中出血量和手术前后VAS评分、JOA评分等。结果所有患者症状均得到改善,术后JOA评分较术前提高,VAS评分降低。两组的手术时间、出血量、JOA评分和VAS评分差异均无统计学意义(P>0.05)。A组中有2例患者术中一侧因骨质疏松明显,椎弓根螺钉置入后把持力不足并出现钉道切割导致置钉失败,仅行对侧固定,其余患者置钉顺利。B组患者手术置钉过程未出现螺钉把持力不佳、置钉失败、皮质骨钉道骨折断裂等情况,所有患者均未出现置钉引起的血管、神经损伤。全部32例患者术后影像学随访未见螺钉松动、脱落、塌陷等,螺钉、连接棒、融合器均在位,位置佳。所有病例无不良事件产生。结论应用CBT螺钉联合椎弓根螺钉技术进行腰椎内固定治疗老年骨质疏松腰椎退变性疾病具有肌肉和软组织损伤小、螺钉把持力强等优势,早期疗效满意。 Objective To observe the clinical effect of internal fixation using cortical bone locus (CBT) screw and pedicle screw in the treatment of lumbar degenerative diseases of senile osteoporosis by posterior decompression and bone graft internal fixation. Methods From February 2014 to April 2015, 32 patients with degenerative lumbar degenerative disease of osteoporosis who were not treated conservatively in Changzheng Hospital of Second Military Medical University were treated with posterior decompression and bone graft fixation. Among them, 20 Simple pedicle screw fixation (group A), 12 cases using CBT screw combined with pedicle screw fixation (group B). The postoperative recovery, operation time, intraoperative blood loss, VAS score before and after surgery, JOA score and so on were observed. Results The symptoms of all patients were improved. The postoperative JOA score increased compared with that before operation, and the VAS score decreased. There was no significant difference in operative time, blood loss, JOA score and VAS score between the two groups (P> 0.05). In group A, 2 patients had obvious osteoporosis on one side, insufficient pedicle screw force after pedicle screw placement, and nailing failure caused by pedicle screw fixation. Only the contralateral fixation was performed and the rest of the patients were successfully placed. In group B, there was no screw-holding failure, nail failure, and fracture of cortical bone screw fracture in the process of nailing. No blood vessel or nerve injury caused by nailing occurred in all patients. All the 32 patients had no screw loosening, falling off and collapsing after the imaging follow-up. The screw, connecting rod and cage were in good position. No adverse events occurred in all cases. Conclusion CBT screw combined with pedicle screw technique for lumbar spine internal fixation for senile osteoporosis lumbar degenerative diseases with small muscle and soft tissue injury, screw holding power and other advantages, the early effect is satisfactory.