腰椎后路峡部植骨钉棒系统固定治疗青年腰椎双侧峡部裂疗效分析

Therapeutic effect analysis of posterior lumbar isthmus bone grafting and screw-rod system fixation for bilateral lumbar spondylolysis in youths

中文关键词:  双侧腰椎峡部裂  长期训练  钉棒系统  手术

英文关键词:Bilateral spondylolysis  Long-term training  Screw-rod system  Surgery

中文摘要:

  【摘要】 目的：探讨腰椎后路峡部植骨钉棒系统固定治疗青年双侧腰椎峡部裂的疗效。方法：回顾性分析2015年10月~2017年10月我院收治的17例青年双侧腰椎峡部裂患者资料，男性13例，女性4例，年龄18~39（25.1±6.1）岁，病程12.7±8.8个月。其中L3节段1例，L5节段16例，致伤原因均为长期体育或军事等训练所致。所有患者均为单纯峡部裂，均采取双侧峡部髂骨植骨、椎弓根螺钉固定术治疗。术后随访12~18个月，平均15.4±2.0个月。通过腰椎CT评价峡部骨折愈合情况，通过腰部视觉模拟评分法（visual analogue score，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）评价临床疗效。随访期间腰椎CT证实峡部骨性愈合后行内固定取出。记录本组患者性别、年龄、病程、责任节段、致伤原因、合并伤、手术切口长度、手术时间、术中出血量、术前和末次随访时的腰椎CT责任节段峡部表现以及腰部VAS评分、脊柱ODI评分，并进行统计学分析。结果：手术切口长度9.1±2.1cm，手术时间168.5±46.4min，术中出血量108.8±61.8ml。所有患者手术切口无感染，均获得甲级愈合。17例患者末次随访时腰椎CT均可见腰椎滑脱恢复，峡部骨性愈合，均行内固定取出。术前、末次随访时，腰部VAS分别为5.8±1.1分和1.2±0.7分，脊柱ODI分别为（35.8±9.1）%和（7.1±2.0）%，差异有统计学意义（P<0.01）。末次随访时有2例患者剧烈活动时偶有腰部疼痛，不影响正常生活。随访期内均无断钉、内固定松动和邻近节段退变等不良并发症。结论：腰椎后路峡部植骨钉棒系统固定治疗青年双侧腰椎峡部裂是一种安全且有效的方法。

英文摘要:

  【Abstract】 Objectives: To investigate the effects of posterior lumbar isthmus screw-rod system fixation and local bone grafting in the treatment of bilateral lumbar spondylolysis in youths. Methods: Data of 17 patients with bilateral lumbar spondylolysis admitted to our hospital from October 2015 to October 2017 were retrospectively analyzed, including 13 males and 4 females, aged 18-39 (25.1±6.1) years, with an average course of 12.7±8.8 months. Among them, 1 case with L3 spondylolysis, and the other 16 cases with L5 spondylolysis, and all were caused by long-term sports or military training. All patients were simple spondylolysis. All patients were treated with iliac bone grafting and pedicle screw fixation. The follow-up period ranged from 12 to 18 months, with an average of 15.4±2.0 months. The fusion status of isthmic was evaluated by lumbar CT scan, and the clinical outcome was evaluated by visual analogue score(VAS) and spinal Oswestry disability index(ODI). During the follow-up period, implant was removed after CT scan confirming the isthmus fusion. Gender, age, disease course, fixed level, cause of injury, combined injuries, incision length, operation time, intra-operative bleeding volume, the CT manifestation of isthmus before operation and at final follow-up, VAS of lumbar spine and ODI of spinal column were collected and analyzed. Results: The average age of 17 patients was 25.1±6.1 years, there were 13 males and 4 females, 16 L5 segments and 1 L3 segments. All patients were followed up for an average of 15.4±2.0 months. The course of disease was 12.7±8.8 months. All of them are simple isthmic fissures. The injuries were caused by long-term sports or military training. The incision was 9.1±2.1cm, the operation time was 168.5±46.4min, intra-operative bleeding volumewas 108.8±61.8ml. No infection was found in the incision of all the patients, and grade A healing was achieved. At final follow-up, lumbar spondylolisthesis recovered and isthmus bone healed in all 17 patients, with implant removed during the follow-up. The preoperative and final follow-up VAS scores were 5.8±1.1 and 1.2±0.7 respectively, and the ODI scores were (35.8±9.1)% and (7.1±2.0)%, respectively(P<0.01). At final follow-up, 2 patients had occasional low back pain during intense activities, which did not influence their normal life. No implant breakage, implant loosening and adjacent segments degeneration were found during the follow-up. Conclusions: Posterior lumbar isthmus bone grafting and screw-rod system fixation is an effective and safe method in the treatment of bilateral lumbar spondylolysis in youths.