腰椎椎弓峡部裂伴I°滑脱单纯峡部植骨与椎弓根钉内固定的疗效对比研究

Bone grafting of the pars defect versus bone graft fusion with trans pedicular fixation for I° isthmic spondylolisthesis

目的 对腰椎椎弓峡部裂伴I°滑脱行嵌入式单纯峡部植骨与植骨加用椎弓根钉内固定的临床疗效进行比较。方法 对 4 3例腰椎椎弓峡部裂伴I°滑脱患者随机行嵌入式单纯峡部植骨 2 0例、植骨加用椎弓根钉内固定 2 3例 ,随访 2 2～ 115个月 ,平均 4 7个月。根据随访X线片和症状改善情况 ,统计植骨融合率和疗效优良率 ,并进行比较。结果 嵌入式单纯峡部植骨和植骨加用椎弓根钉内固定的融合率分别为 85 %和 91.3% ,优良率分别为 85 %和 91.3% ,统计学分析无显著差异 ,但前者并发症少于后者。结论 对于腰椎椎弓峡部裂伴I°滑脱患者两种治疗方法均能取得满意疗效 ,单纯嵌入式植骨的术式简单、并发症少 ,但卧床时间较长。

Objective To determine whether the bone graft fusion with transpedicular fixation in patients with I°isthmic spondylolisthesis results in an improved outcome as compared with the bone grafting of the pars defect only. Methods 43 patients were randomly allocated to the bone grafting of the pars defect without transpedicular fixation (n=20) or the bone graft fusion with transpedicular fixation (n=23). The followup period is 22 to 115 months ( average 47 months). The outcome was evaluated according to the function and imaging changes. Results By comparing the two different methods, which were the bone grafting of pars defect with and without transpedicular fixation, the good rates of functional outcome were 85% and 91.3%, and the fusion rates were 85% and 91.3% respectively. Statistically, there is no significant difference between the results of the two methods. Conclusions The bone graft fusion without and with transpedicular fixation in patients with I°isthmic spondylolisthesis results in an similar functional outcome and fusion rate. The direct repair of spondylolysis with bone grafting of the pars defect is simple and the complications are rare. However, the patients treated with this method need more days to stay on the bed.