急性创伤性腰椎滑脱症的临床特征及后路手术治疗

The clinical features and posterior operation for traumatic lumbar spondylolisthesis

中文关键词:  创伤  腰椎滑脱  内固定  椎间融合术

英文关键词:Trauma  Lumbar spondylolisthesis  Internal fixation  Interbody fusion

中文摘要:

  【摘要】 目的：探讨急性创伤性腰椎滑脱症的临床特征及后路手术治疗的近期疗效。方法：回顾分析2009年8月~2013年6月收治的9例急性创伤性腰椎滑脱症患者临床资料。男5例，女4例；年龄平均36.5±±16.3岁（21~60岁）；致伤原因：重物砸伤3例，高处坠落伤4例，交通事故伤2例。术前神经功能Frankel分级为：E级1例，D级4例，C级3例，B级1例。X线片示L4滑脱3例，L5滑脱6例。滑脱程度根据Meyerding分级：Ⅰ度2例，Ⅱ度4例，Ⅲ度2例，Ⅳ度1例。9例患者均行后路椎弓根螺钉内固定和椎间植骨融合术，术后随访行腰椎正侧位X线片及CT三维重建评价滑脱复位及植骨融合情况；通过疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）进行疗效评价。结果：9例术后均获随访，随访时间平均35.0±11.6个月（12~58个月）。术后2周及末次随访时VAS（2.6±0.6、2.1±0.4）、ODI（16.2±2.5、15.3±2.1）评分均较术前（7.3±1.2和69.7±12.3）显著改善（P<0.05），术后2周和末次随访间比较差异无统计学意义（P>0.05）；术后随访内固定位置良好，CT三维重建显示患者植骨均融合，融合时间平均9.6±？个月（6~12个月）；末次随访时腰椎X线侧位片示滑脱Meyerding分级：0度6例，Ⅰ度2例，Ⅱ度1例；末次随访时神经功能Frankel分级：E级6例，D级2例，C级1例。结论：急性创伤性腰椎滑脱均为严重创伤所致，易发生在L5和L4，均伴韧带及关节囊损伤、关节突及附件或峡部骨折，经后路椎弓根内固定和椎间融合术可获得良好的影像学及临床疗效。

英文摘要:

  【Abstract】 Objectives: To explore the clinical characteristics and preliminary outcome of posterior operation for traumatic lumbar spondylolisthesis. Methods: Between August 2009 and June 2013, 9 patients(5 males and 4 females; average age: 36.5±16.3 years, range: 21 to 60 years) with traumatic lumbar spondylolisthesis undergoing surgeries were retrospectively reviewed. The mechanism of injury included heavy blow injury in 3 cases, high fall injury in 4 cases, and traffic accident injury in 2 cases. According to Frankel neurological function grade system, 1 patient was rated as grade E, 4 as grade D, 3 as grade C before operation; the affected segment included L4 in 3 patients and L5 in 6 patients based on X-ray films before operation. According to Meyerding spondylolisthesis grading, 2 cases were classified as degree Ⅰ, 4 as degree Ⅱ, 2 as degree Ⅲ, and 1 as degree Ⅳ. The reduction of spondylolisthesis and bone graft fusion were assessed on X-ray films and three-dimensional CT scans during follow-up. The clinical outcomes were evaluated by visual analogue scale(VAS) and Oswestry disability index(ODI) scores. Results: All patients had a follow-up of 12-58 months(average: 35.0±11.6 months). At 2 weeks after operation and last follow-up, VAS scores(2.6±0.6, 2.1±0.4) and ODI scores(16.2±2.5, 15.3±2.1) significantly improved compared with the preoperative ones(7.3±1.2, 69.7±12.3)(P<0.05); however, no significant difference was found between 2 weeks after operation and last follow-up (P>0.05). The reontgenograph showed good position of the instrument after operation. The fusion rate was 100% based on three-dimensional CT scans, and the fusion time was 6-12 months. At the last follow-up, the spondylolisthesis was degree 0 in 6 cases, degree Ⅰ in 2 cases and degree Ⅱ in 1 case according to Meyerding grading; the Frankel neurological function was grade E in 6 cases, grade D in 3 cases, and grade C in 1 case. Conclusions: Acute traumatic lumbar spondylolisthesis is always caused by severe trauma and mostly occurred at L5, L4 level, and combined with ligament and joint capsule injury, facet fracture. Posterior transpedicular screw system and interbody fusion can get satisfactory radiological and clinical outcome.