青少年L5/S1滑脱后路内固定复位术后即刻复位效果及其影响因素

Posterior instrumentation and reduction for L5/S1 spondylolisthesis in adolescents: the immediate reduction outcome and its associated risk factors

中文关键词:  青少年  腰椎滑脱症  峡部裂  发育不良  复位

英文关键词:Adolescent  Spondylolisthesis  Isthmic  Dysplastic  Reduction

中文摘要:

  【摘要】 目的：研究青少年L5/S1滑脱后路椎弓根螺钉固定复位术后即刻复位疗效及影响因素。方法：回顾性分析2002年5月～2014年12月间收治的30例青少年L5/S1滑脱患者的病例资料。男13例，女17例，年龄10～20岁，平均14.5岁；峡部裂性滑脱21例，发育不良性滑脱9例；根据Meyerding分度，Ⅰ度滑脱16例，Ⅱ度滑脱7例，Ⅲ度滑脱4例，Ⅳ度滑脱3例。均接受后路椎弓根螺钉内固定复位术治疗（24例行单节段L5～S1融合，余6例行L4～S1融合），评价复位效果并分析复位率与术前影像学参数（腰椎前凸角、骨盆入射角、骨盆倾斜角、骶骨倾斜角、椎间隙相对高度、滑脱率、滑脱角及滑脱距离）的相关性。结果：本组患者术前平均腰椎前凸角52°±16°，平均骨盆入射角62°±13°，平均骨盆倾斜角24°±16°，平均骶骨倾斜角38°±15°，平均滑脱率（33.6±24.2）％，平均滑脱角13°±9°，平均滑脱距离9.1±6.6mm，平均椎间隙相对高度0.31±0.1。术后平均复位率（87.3±14.7）％。术后即刻复位率与术前骨盆入射角、骶骨倾斜角无明显相关性（P>0．05），与腰椎前凸角（r=0.458，P<0．05）及术前椎间隙相对高度（r=0.822，P<0．01）呈正相关，与骨盆倾斜角（r=-0.519，P<0．01）、滑脱率（r=-0.567，PP<0．01）、滑脱角（r=-0.573，P<0．01）及滑脱距离（r=-0.502，P<0．01）负相关。结论：青少年L5/S1滑脱经后路内固定复位术后可达有效复位。复位效果受病因学、融合方式、术前滑脱率以及术前椎间隙相对高度等多种因素影响。术中撑开椎间隙有助于滑脱复位。

英文摘要:

  【Abstract】 Objectives: To identify the immediate reduction outcome and its associated risk factors of posterior instrumentation and reduction for adolescent patients with L5/S1 spondylolisthesis. Methods: In this study, adolescents with isthmic(n=21) or dysplastic(n=9) spondylolisthesis at L5/S1 were recruited in our hospital from May 2002 to Deccmber 2014. The average age was 14.5 years(range, 10-20 years). There were 13 males and 17 females. According to Meyerding grade, 16 cases in grade Ⅰ, 7 in Ⅱ, 4 in Ⅲ and 3 in Ⅳ. All patients underwent posterior pedicle screw instrumentation(L5-S1 single segment fusion for 24 cases, L4-S1 double segment fusion for 6 cases). The relationship between reduction rate and preoperative radiographic parameters including lumbar spine lordosis Cobb′s angle, pelvic incidence, pelvic tilt, sacral slope, disc height, slippage rate, slippage angle and slippage distance was evaluated. Results: Before surgery, the average lumbar lordosis(LL) was 52°±16°, the average pelvic incidence(PI) was 62°±13°, the average pelvic tilt(PT) was 24°±16°, the average sacral slope(SS) was 38°±15°, the average slippage percentage(SP) was (33.6±24.2)％, the average slippage angle(SA) was 13°±9°, the average slippage distance(SD) was 9.1±6.6mm, and the average intervertebral disc relative height was 0.31±0.1. After the posterior instrumentation and fusion surgery, the average reduction rate of L5 slippage was (87.3±14.7)％. Among the preoperative radiographic parameters, immediate reduction rate was found to be strongly correlated with the disc relative height and LL, while negatively correlated with PT, SP, SA and SD. Conclusions: Effective reduction of L5/S1 slippage in adolescents can be successfully achieved by posterior instrumentation and reduction. Various factors may impact on the immediate reduction rate including etiology, fusion method, slip severity, and disc relative height. During the surgery, managing the intervertebral disc help improve reduction rate of slippage.