经椎旁肌间隙入路与后正中入路手术治疗青年峡部裂症的疗效比较

Wiltse and midline approach for lumbar spondylolysis in adolescent: a randomized controlled trial

中文关键词:  峡部裂症  经椎旁肌间隙入路  后正中入路  有效性

英文关键词:Spondylolysis  Wiltse approach  Midline approach  Effectiveness

中文摘要:

  【摘要】 目的：比较经椎旁肌间隙入路与后正中入路峡部植骨融合钉钩内固定治疗青年峡部裂症的临床疗效。方法： 2006年3月~2010年5月，我院收治青年峡部裂症患者28例，其中L3 4例，L4 8例，L5 16例。随机分为两组，均接受峡部植骨融合钉钩内固定治疗，其中14例经椎旁肌间隙入路（A组）、14例经后正中入路（B组），术前两组患者年龄、性别比、节段分布、VAS评分和ODI均无显著性差异。记录两组患者手术时间、术中出血量及术后引流量；术后3d、3个月、6个月、1年、2年时采用VAS评分评估术后腰部疼痛情况；术前、术后3个月、6个月、1年、2年采用ODI评估腰部功能恢复情况；术后1年采用三维CT评价植骨融合情况。结果：A组手术时间100～140min，平均104min，术中出血80～150ml，平均124ml，术后引流35～85ml，平均54ml；B组手术时间120～160min，平均133min，术中出血120～210ml，平均197ml，术后引流53～122ml，平均80ml。A组较B组手术时间缩短、出血量少（P＜0.05）。术后3d时A组患者VAS评分（6.31±0.9分）明显高于B组（4.79±1.1分）（P＜0.05），但3个月和6个月时A组VAS评分及ODI（VAS：1.13±1.2分、1.07±1.4分；ODI：0.135±0.099、0.137±0.041）低于B组（VAS：2.93±1.7分、2.36±1.3分；ODI：0.187±0.112 0.179±0.029）（P＜0.05），12个月及2年随访时两组VAS评分及ODI无显著性差异（P＞0.05）。术后1年时三维CT重建两组各有13例峡部裂处形成连续骨桥，植骨融合率均为92.8%，均未见内固定松动、脱出。结论：采用经椎旁肌间隙入路植骨融合钉钩内固定治疗青年峡部裂症较经后正中入路创伤小，手术时间短，术后恢复快，可获得较满意疗效。

英文摘要:

  【Abstract】 Objectives: To compare the effectiveness, advantages and disadvantages of Wiltse and midline approach for lumbar spondylolysis in adolescent by vertebral pedicle screw-vertebral plate Hook system. Methods: Randomized controlled trial was carried out on 28 cases of spondylolysis(young patients) of our hospital from March 2006 to May 2010(L3 in 4 cases, L4 in 8 cases, L5 in 16 cases), all cases underwent either Wiltse(14 cases) or midline approach(14 cases). Age, sex-ratio, segment distribution, visual analogue scale(VAS) score and Oswestry dysfunction index(ODI) scale showed no group-related difference. Operation time, operative blood loss and postoperative drainage were recorded. The VAS was used to assess pain at postoperative 3 days, 3 months, 6 months, one year and two years; the ODI was used to assess the functional recovery in preoperative and postoperative 3 months, 6 months, one year and two years; the three dimensional CT was used to evaluate fusion status one year after operation. Results: For Wiltse approach, the average operation time was 104min(100-140min)， the average intraoperative blood loss was 124ml（80-150ml）, the postoperative drainage was 54ml(35-85ml). For midline approach, the average operation time was 133min(120-160min)， the intraoperative blood loss was 197ml(120-210ml) and the postoperative drainage was 80ml(53-122ml), all showed higher value than Wiltse approach group(P＜0.05). Witlse approach group had higher VAS score(6.31±0.9) than midline approach group(4.79±1.1) in postoperative 3 days(P＜0.05), while had lower VAS and ODI(VAS: 1.13±1.2, 1.07±1.4; ODI: 0.135±0.099, 0.137±0.041) than Midline approach(VAS: 2.93±1.7, 2.36±1.3; ODI: 0.187±0.112, 0.179±0.029) in postoperative 3 and 6 months(P＜0.05), while two groups showed no difference in postoperative 12 and 24 months(P＞0.05). The three dimensional CT showed continuous bony bridging in 13 cases of both groups in postoperative one year, with the fusion rate of 92.8%, no instrument failure was noted. Conclusions: Treatment of lumbar spondylolysis in adolescent by vertebral pedicle screw-vertebral plate Hook system through Witlse approach is reliable and effective with less invasive than midline approach.