患椎钉棒固定峡部植骨治疗青少年腰椎峡部裂

Rod-screw fixation of the affected vertebra combined with bone autografting of the pars defect for lumbar isthmic spondy⁃ lolysis in adolescent

摘要:

[目的] 评价患椎钉棒固定峡部植骨治疗青少年腰椎峡部裂的临床疗效。[方法] 2013 年 5 月—2016 年 7 月，本科采用患椎钉棒固定峡部植骨治疗青少年腰椎峡部裂 31 例，均为男性；年龄 17~29 岁，主要症状为腰痛。评价临床与影像结果。[结果] 所有患者均顺利完成手术，术中无神经、血管损伤等严重并发症，手术时间 (109.10±15.12) min，术中出血量 (133.55±58.12)ml。31 例患者均获随访，随访时间 13~35 个月，平均(17.65±4.22)个月，随时间推移，ODI 和 VAS 评分显著降低 (P＜0.05)。影像方面，随时间推移，LL 显著减少 (P＜0.05)；峡部连接率显著增加 (P＜0.05)。随访过程中无内固定松动、断钉断棒。末次随访时所有患者均获得椎弓峡部骨性愈合。[结论] 对青少年单纯腰椎峡部裂患者，患椎钉棒固定峡部植骨是一种简单、效果确切的手术方式。

Abstract:

[Objective] To evaluate the clinical outcomes of rod-screw fixation of the affected vertebra combined with bone autograft- ing of the pars defect for lumbar isthmic spondylolysis in adolescents. [Methods] From May 2013 to July 2016, a total of 31 patient who all were male and aged from 17 to 29 years with the main symptom of lumbago, underwent abovementioned surgical procedures for lumbar isth- mic spondylolysis in our department. The clinical and imaging consequences were evaluated. [Results] All patients were successfully oper- ated on without serious complications such as nerve and vascular injuries, whereas with operative time of (109.10±15.12) min, and the intra- operative blood loss of (133.55±58.12) ml. As time went during the follow-up lasted for 13~35 months, with an average of (17.65±4.22) months, the ODI and VAS scores decreased significantly (P＜0.05) . In terms of imaging evaluation, the lumbar lordosis (LL) decreased sig- nificantly (P＜0.05) , whereas the isthmic union ratio increased significantly over time (P＜0.05) . No loosening or breaking of the rod-screw system was noticed during follow-up in anyone of them, whereas bony union of the isthmus was achieved in all patients at the last followup. [Conclusion] This rod-screw fixation of the affected vertebra combined with bone autografting of the pars defect is a simple and effec- tive surgical method for lumbar isthmic spondylolysis in adolescents.