椎板钩与椎弓钉固定儿童青少年腰椎峡部裂比较△

Lamina hook versus pedicle screw for fixation of lumbar spondylolysis in children and adolescents

摘要:

[目的]比较椎板钩与椎弓钉固定治疗儿童单纯性双侧腰椎峡部裂的疗效。[方法]回顾性分析 2016 年1月—2019 年 1 月手术治疗的 43 例儿童单纯双侧腰椎峡部裂患者的临床资料。根据医患沟通结果，20 例行椎板钩内固定，23 例行椎弓钉固定。比较两组围手术期、随访及影像结果。[结果]两组患者均顺利手术，椎板钩组手术时间 [(79.9±7.8) min vs (103.9±8.6) min, P＜ 0.05]、切口长度 [(6.2±0.9) cm vs (7.8±0.8) cm, P＜0.05] 和术中失血量 [(120.8±16.2) ml vs (177.0±12.8) ml, P＜0.05] 均显著优于椎弓钉组，两组术中透视次数、下地行走时间、切口愈合情况、住院时间的差异均无统计学意义（P＞0.05）。两组患者均获随访 24 个月以上，两组完全负重活动时间的差异无统计学意义（P＞0.05），随时间推移，两组 VAS 评分、ODI 指数均显著减少（P＜0.05），术后 3 个月椎板钩组 VAS 评分 [(2.0±0.7) vs (2.4±0.5), P＜0.05]、ODI 评分 [(30.2±6.0) vs (38.7±2.5), P＜0.05] 均显著优于椎弓钉组，末次随访时两组差异无统计学意义（P＞0.05）。影像方面，两组患者术后 6 个月峡部完全愈合。相应时间点两组椎间隙高度、腰椎前凸角差异均无统计学意义（P＞0.05）[结论]椎与椎弓钉固定相比，板钩固定儿童单纯腰椎峡部裂手术创伤小，临床效果优。

Abstract:

[Objective] To compare the clinical efficacy of fixation with laminar hook versus pedicale screw for treatment of simple bilat- eral lumbar spondylolysis in children and adolescent. [Methods] A retrospective study was performed on 43 patients who received surgical treatment for simple bilateral spondylolysis in our department from January 2016 to January 2019. According to doctor-patient communica- tion, 20 patients underwent internal fixation with laminar hooks (LH), while the other 23 patients underwent fixation with pedicle screw (PS). The perioperative, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups were successful- ly operated on. The LH group proved significantly superior to the PS group in terms of operation time [(79.9±7.8) min vs (103.9±8.6) min, P＜ 0.05], incision length [(6.2±0.9) cm vs (7.8±0.8) cm, P＜0.05] and intraoperative blood loss [(120.8±16.2) ml vs (177.0±12.8) ml, P＜0.05]. However, there was no statistical significance in the number of intraoperative fluoroscopy, postoperative walking time, incision healing scale and hospital stay between the two groups (P＞0.05). Patients in both groups were followed up for more than 24 months, and there was no statis- tical significance in the time to resume full weight-bearing activities between the two groups (P＞0.05). As time went on, the VAS and ODI scores significantly decreased in both groups (P＜0.05). The LH group was significantly better than the PS group in terms of VAS score [(2.0± 0.7) vs (2.4±0.5), P＜0.05], ODI score [(30.2±6.0) vs (38.7±2.5), P＜0.05] 3 months postoperatively, whereas which became not statistically sig- nificant at the latest follow-up (P＞0.05). Regarding to imaging, the isthmus was completely healed within 6 months postoperatively in all pa- tients of both groups. There were no statistically significant differences in intervertebral height and lumbar lordosis angle between the two groups at any corresponding time points (P＞0.05). [Conclusion] The laminar hook used for fixation of simple lumbar spondylolysis in chil- dren takes advantages of decreasing iatrogenic trauma and improving clinical outcomes over the pedicle screw fixation.