椎弓和椎板钉固定青少年症状性峡部裂

Pedicle screws and laminar screws for fixation of symptomatic lumbar spondylolysis in adolescents

摘要:

[目的] 探讨椎弓和椎板钉固定 (“双稳定构型”) 结合峡部植骨治疗青少年症状性腰椎峡部裂的临床疗效。[方法] 回顾性分析 2019 年 1 月—2021 年 12 月在本院骨科采用上述技术治疗的青少年症状性腰椎峡部裂 33 例患者的临床资料。 评估临床与影像资料。[结果]所有患者顺利完成手术，无严重并发症。术前 9 例 I 度滑脱患者中，术中 C 形臂监视下证实 8 例达到解剖复位，复位率 88.9%。术后随访 12 个月以上，随时间推移、VAS 评分及 ODI 指数显著下降(P＜0.05)。影像方面，峡部融合时间为 3~12 个月，末次随访时仅 2 例患者峡部植骨内固定术后未愈合，植骨愈合率 93.9%。至末次随访时未见内固定松动断裂、邻近节段退变。[结论]“双稳定构型”固定联合峡部植骨治疗青少年症状性腰椎峡部裂具有手术时间短、并发症少、恢复快，峡部愈合率高的优点。

Abstract:

[Objective] To investigate the clinical outcomes of pedicle screws and laminar screw (the double- stable construct) com- bined with isthmus bone autografting for symptomatic lumbar spondylolysis in adolescents. [Methods] A retrospective study was performed on 33 adolescent patients who received abovesaid surgical procedures for symptomatic lumbar spondylolysis in our hospital from January 2019 to December 2021. Clinical and imaging data were evaluated. [Results] All patients had operation performed successfully without seri- ous complications. Among the 9 patients with Grade I spondylolisthesis before surgery, 8 patients were confirmed to have achieved anatomic reduction under fluoroscopy, with a reduction rate of 88.9%. With time of follow-up lasted for more than 12 months, VAS and ODI scores de- creased significantly (P＜0.05) . In terms of imaging, the bony healing time of isthmus ranged from 3 months to 12 months. At the last followup, all the patients got isthmic bony healing except 2 patients, with healing rate of bone grafting of 93.9%, whereas with no loosening and fracture of the implants, nor degeneration of adjacent segments. [Conclusion] This double-stable construct fixation combined with isthmic bone grafting has the advantages of short operation time, less complications, fast recovery and high isthmus healing rate for symptomatic lum- bar spondylolysis in adolescent.