应用笑脸棒技术治疗腰椎峡部裂伴Ⅰ度滑脱的临床疗效

Clinical efficacy of smiley face rod technique in the treatment of lumbar spondylolysis with grade Ⅰ spondylolisthesis

中文关键词:  腰椎  峡部裂  笑脸棒技术

英文关键词:Lumbar spine  Spondylolysis  Smiley face rod technique

中文摘要:

  【摘要】 目的：探讨应用笑脸棒（smiley face rod，SFR）技术治疗腰椎峡部裂伴Ⅰ度滑脱的临床疗效。方法：回顾性分析我科2019年1月~2024年12月应用SFR节段内固定技术治疗的腰椎峡部裂伴Ⅰ度滑脱患者22例，其中男性18例，女性4例，年龄12~55岁（28.7±12.6岁），体质指数（body mass index，BMI） 18~29kg/m2（22.7±3.4kg/m2），术前病程6~60个月（12.3±14.3个月），随访时间6~19个月（9.1±4.5个月）。记录手术时间及术中出血量。术前、术后3个月、6个月采用腰痛视觉模拟量表（visual analogue scale，VAS）评分、Oswestry功能障碍指数（Oswestry disability index，ODI）和日本骨科协会（Japanese Orthopaedic Association，JOA）评分评估临床效果。术前和术后6个月行X线、CT等检查，测量术前和术后椎间盘高度、滑移距离、滑移率、腰椎前凸角、椎间隙活动范围，评价患者术后滑脱改善程度、活动度及骨愈合情况。分析年龄、BMI及术前病程与峡部骨愈合率的相关性。结果：手术时间86~200min（131.8±32.8min），出血量50~150mL（86.4±41.4mL）。术后患者腰骶部疼痛明显缓解，术后3个月及6个月时VAS评分、ODI及JOA评分均较术前明显改善（P<0.05）。与术前相比，术后6个月滑脱距离、滑移率、前凸角明显下降（P<0.05）。术前与术后6个月的手术节段和上一节段的椎间盘高度比、手术间隙和上一节段椎间隙活动范围均无明显差异（P<0.05）。术后6个月随访时峡部裂骨完全愈合率为81.82%（18/22），一侧峡部骨愈合及其他类型部分骨愈合率为13.63%（3/22），不愈合率为4.55%（1/22）。年龄、BMI及术前病程是影响骨愈合情况的潜在因素。结论：应用SFR技术治疗腰椎峡部裂伴Ⅰ度滑脱可有效提高术后腰椎稳定性，显著改善腰痛症状，保留腰椎运动功能，一定程度避免椎间盘高度塌陷。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical efficacy of the smiley face rod(SFR) technique in treating lumbar spondylolysis with grade Ⅰ spondylolisthesis. Methods: A total of 22 patients(18 males, 4 females) with lumbar spondylolysis and grade I spondylolisthesis treated with the SFR segmental fixation technique in our department from January 2019 to December 2024 were retrospectively analyzed. The age of the patients was 12-55(28.7±12.6) years old, the body mass index(BMI) was 18-29kg/m2(22.7±3.4kg/m2), and preoperative symptom duration was 6-60(12.3±14.3) months. The patients were followed up for 6-19(9.1±4.5) months. The operative time and intraoperative blood loss volume were recorded. Before opearation, at 3 months and 6 months after operation, visual analogue scale(VAS) for low back pain, Oswestry disability index(ODI), and Japanese Orthopaedic Association(JOA) scores were recorded to evaluate the clinical outcomes. Imaging examinations(X-ray, CT) were performed before operation and at 6 months after operation to measure preoperative and postoperative disc height(DH), slip distance(SD), slip rate, lumbar lordosis angle, and range of motion(ROM) at the surgical and adjacent segments to assess the improvement of spondylolisthesis and ROM, as well as the pars defect healing status. The correlations between age, BMI, preoperative disease duration and isthmus bone healing rate were studied. Results: The operative time was 131.8±32.8min(range: 86-200min), and intraoperative blood loss was 86.4±41.4mL(range: 50-150mL). Significant improvements in VAS, ODI and JOA scores were observed at 3 months and 6 months versus preoperative values(P<0.05). Slip distance, slip percentage, and lumbar lordosis angle significantly decreased at 6 months versus preoperatively(P<0.05). No significant differences were observed in DH ratio or ROM between the surgical and adjacent segments preoperatively and at 6 months(P<0.05). At 6-month follow-up, complete bilateral pars bony union was achieved in 18 cases(81.82%), partial union(including unilateral or other types) in 3 cases(13.63%), and nonunion in 1 case(4.55%). Age, BMI, and preoperative symptom duration showed potential influence on bone healing. Conclusions: In the treatment of lumbar spondylolysis with grade Ⅰ spondylolisthesis, SFR can effectively enhance postoperative lumbar stability, significantly alleviate low back pain symptoms, preserve lumbar mobility, and mitigate disc height collapse to a certain extent.