峡部螺钉联合非融合椎弓钉固定腰椎峡部裂△

Isthmic screw combined with non- fusion pedicle screw fixation for lumbar spondylolysis

摘要:

［目的］ 探讨峡部螺钉结合非融合椎弓钉固定治疗腰椎峡部裂的临床疗效。［方法］ 2015 年 1 月—2019 年 6 月，应用峡部螺钉结合非融合椎弓钉固定治疗腰椎峡部裂或伴 I 度滑脱或盘源性腰痛的患者 21 例，观察临床与影像结果。［结果］21 例患者均顺利完成手术，术中无血管、神经损伤、脑脊液漏等并发症发生，手术时间平均（130.15±29.72）min，术中出血量平均 （215.64±58.51）ml。所有患者均获随访（32.62±9.43）个月，随时间推移，患者 VAS 和 ODI 评分较术前明显减少（P<0.05）。术后 18 个月峡部裂骨性融合率为 100%。末次随访时 UCLA 系统评价与术前相同，未发现邻近节段退变加重情况。［结论］峡部螺钉结合非融合椎弓钉固定治疗腰椎峡部裂或伴 I 度滑脱或盘源性腰痛是安全有效的，峡部融合率满意。

Abstract:

[Objective] To investigate the clinical outcome of isthmic screw combined with non-fusion pedicle screw fixation for lumbar spondylolysis. [Methods] From January 2015 to June 2019, 21 patients underwent isthmic screw combined with non-fusion pedicle screw fixation for lumbar spondylolysis accompanied with or without grade I spondylolisthesis or discogenic low back pain. Clinical and imaging re- sults were observed. [Results] All the 21 patients had operation completed successfully, without neurovascular injury, cerebrospinal fluid leakage and other complication, while with operation time of (130.15±29.72) min and intraoperative blood loss of (215.64±58.51) ml on aver- age. With time of follow-up lasted for (32.62±9.43) months, the VAS and ODI scores significantly decreased (P＜0.05) . Radiographically, the fusion rate of isthmic defect was of 100% 18 months after operation, whereas no deterioration of adjacent-segment degeneration was no- ticed at the latest follow-up compared with that preoperatively in term of UCLA criteria. [Conclusion] Isthmic screw combined with non-fu- sion pedicle screw fixation is a safe and effective treatment for lumbar spondylolisthesis with or without grade I spondylolisthesis and disco- genic low back pain with a satisfactory fusion rate of the isthmic defect.