应用Smiley face rod固定系统治疗L5椎弓峡部裂的疗效分析

The clinical outcome of the treatment of isthmic spondylolysis with Smiley face rod fixation system

中文关键词:  腰椎  峡部裂  Smiley face rod固定系统

英文关键词:Lumber spine  Isthmic spondylolysis  Smiley face rod fixation system

中文摘要:

  【摘要】 目的：探讨应用Smiley face rod固定系统治疗L5椎弓峡部裂的临床疗效。方法：2016年1月～2017年6月，我科采用Smiley face rod固定系统节段内固定植骨融合治疗腰椎峡部裂患者18例，男13例，女5例，年龄28.2±3.2岁（25～32岁），术前平均病程为16.3±5.7个月（7～24个月）。峡部裂节段均位于L5。术后3个月、1年时进行随访，对患者进行疼痛视觉模拟评分（visual analogue scale，VAS）及Oswestry功能障碍指数（Oswestry disability index，ODI）评定，评价其临床治疗效果。行X线、CT等检查，分析术前和术后L5/S1椎间活动度变化及椎间不稳发生率变化情况，并评价患者术后植骨融合情况。结果：手术时间平均90.0±24.1min，术中出血量平均140±15ml。平均随访18.5±5.0个月（12~24个月）。术前VAS评分为7.3±2.5分，ODI为（67.0±15.1）％；术后3个月时分别为3.0±1.2分和（17.2±4.5）％，较术前明显改善（P＜0.05）；术后1年时分别为1.0±0.6分和（9.1±5.3）％，较术后3个月时进一步改善（P＜0.05）。术前L5/S1间隙活动度为13.1°±2.1°，存在腰椎不稳或小于Ⅰ度滑脱者共15例（83.3%，15/18）；术后1年时分别为9.3°±1.6°和2例（11.1%，2/18），两者之间存在统计学差异（P＜0.05）。术后1年时随访患者峡部裂均获得骨性愈合。结论：应用Smiley face rod固定系统治疗L5椎弓峡部裂具有创伤小、对神经干扰少、恢复正常的解剖结构、提高椎间稳定性的优点。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical outcome of Smiley face rod fixation system for lumbar isthmic spondylolysis. Methods: From January 2016 to June 2017, 18 patients with isthmic spondylolysis were treated with smiley face screw-rod fixation system. There were 13 males and 5 females, with an average age of 28.2±3.2(25-32) years old. The average disease duration was 16.3±5.7(7-24) months. L5 isthmic spondylolysis was involved in all cases. All patients had been followed up at 3 months and 1 year after surgery. The preoperative and postoperative visual analogue scale(VAS) and Oswestry disability index(ODI) were compared. The X-ray and CT scan were evaluated to analyze the change of range of motion in the lumber spine and the bony fusion rate. Results: The mean operation time was 90.0±24.1 minutes. The average blood loss was 140±15ml. The average follow-up was 18.5±5.0(12-24) months. The VAS at 3 months after operation was 3.0±1.2, and the ODI was (17.2±4.5)% respectively, which showed significant differences compared with the preoperative ones[7.3±2.5 and (67.0±15.1)％](P＜0.05). The VAS and ODI at 1 year after operation were 1.0±0.6 and (9.1±5.3)%, which showed significant differences compared with 3 months postoperation(P＜0.05). The range of motion between L5 and S1 was 13.1°±2.1° and the incidence of lumbar instability was 83.3%(15/18) preoperatively; it was 9.3°±1.6° and 11.1%(2/18) postoperatively, and there was statistic difference(P＜0.05). All patients achieved bone fusion in the isthmic defect 1 year after operation. Conclusions: The Smiley face rod fixation is a reliable treatment for lumbar spondylolysis with the advantage of minimal invasive, less nerve interference, and to restore normal anatomical structure, maintain the lumbar spine stability.