| Objective:To explore the feasibility of inserting lumbar cortical bone trajectory screws by the navigation of cortical bone resistance.Methods:This study was retrospectively analyzed.During the period from April 2021 to April 2022,the clinical data of 76 patients with lumbar degenerative diseases fixed by cortical bone trajectory screws which were implanted by the navigation of cortical bone resistance were included.Count the patient’s gender,age,patient diagnosis,number of nail-related fluoroscopy,operation time,amount of bleeding,whether there are nail-related complications(screw trajectory explosion,dura,nerve,vascular injury),number of screws,screw size,nail placement.Preoperative ODI and 3-month follow-up ODI were recorded.Postoperative X-ray and CT data were used on Mimics to measure the failure of the medial wall of the pedicle according to the Gertzbein-Robbins medial wall scoring system,and the lateral angle and cephaled angle of the screw after surgery were measured.Evaluation of the superior-segment facet-joint violation by cortical bone trajectory screws is assessed according to the methods of Seo et al.On the positive lateral position of the lumbar spine and CT after surgery,observe whether there are screws loose,broken,pulled,and other adverse conditions.The differences in ODI before and 3 months after surgery,lateral angle and cephalad angle of different segments,and the failure rate of the medial pedicle wall between different segments and positions were statistically analyzed.Results:Among the 76 patients,40 were males and 36 were females.The mean age was50.13 ± 13.70 years(range 17-78 years).There were 61 patients with lumbar disc herniation,10 cases of lumbar spinal stenosis and 5 cases of lumbar spondylolisthesis.Number of pin-related perspectives: 4.34 ± 0.76 times.Operation time: single segment: 240 ± 60.59min;Double segment: 317.66 ± 83.05 min.Bleeding volume:single segment: 129.68 ± 63.42ml;Double segment: 169.23 ± 105.16 ml.There are no screw trajectory explosions,dural,nerve,vascular injuries and other complications associated with nailing.5.5 x 35 mm size screws 85pcs;5.5 x 30 mm 61pcs;5.5 x40 mm 41pcs;5.0 x 35 mm 11pcs;5.0 x 30 mm 1pcs.The number of cortical bone trajectory screws implanted at each pedicle is as follows: L3 right,n=6;L3 left,n=7;L4 right,n=47;L4 left,n=49;L5 right,n=31;L5 left,n=31.ODI preoperatively:72.24 ± 15.46;3 months after surgery: 28.89 ± 9.38(P <0.01),with significant improvement.A total of 171 screws were placed.Among them,there are 167 A-class screws,accounting for 97.66%;and 4 B-class screws,accounting for 2.34%;without C and D screws.The inner wall failure rate of L3 segment was 7.69%;The inner wall failure rate of L4 segment was 2.08%;The inner wall failure rate of the L5 segment was 1.61%.There was no significant difference in the failure rate of the medial wall between different segments(P >0.05).The failure rate of the medial wall of pedicle nails on the right side of the lumbar spine was 2.38%,and the failure rate of the medial wall of pedicle nails on the left side of the lumbar spine was 2.30%.There was no significant difference in the destruction rate of the medial wall between the left and right sides(P >0.05).Postoperative lateral angle: L3:7.9 ± 3.4°;L4:10.1 ± 4.9°;L5:11.7 ± 5.5°。 Postoperative cephalad angle: L3: 28.2 ± 5.5°;L4:26.0 ± 5.1°;L5:27.5 ± 5.7°。 There was no significant difference in lateral angle between different segments(P >0.05).There was no significant difference in cephalad angle between different segments(P >0.05).Superior articular process invasion: grade 0 : 128 screws(87.1%),;grade 1: 6 screws(4.1%);Grade 2: 13 screws(8.8%),superior articular invasion rate of 12.9%.After surgery,there were no abnormalities such as screw displacement and fracture in the lumbar spine imaging data.Conclusion:The navigation of cortical bone resistance is feasible to insert lumbar cortical bone trajectory screws with less medial pedicle wall failure rate. |
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