空心加压螺钉治疗腰椎峡部裂症的远期疗效观察

Surgical Treatment of Lumbar Spondylolysis with Hollow Compression Nail and Bone Grafting

目的观察应用空心加压螺钉治疗腰椎峡部裂症的远期临床疗效。方法使用空心加压螺钉内固定植骨术治疗腰椎峡部裂症患者23例,男13例,女10例;年龄19~46岁,平均34岁。7例L4椎弓崩裂,16例L5椎弓崩裂,均为双侧病变。所有患者均主诉腰痛。采用后中入路,彻底清除峡部裂处的纤维瘢痕组织,咬除残端硬化骨至新鲜处为止,髂后上棘取骨植于峡部裂处。植入空心加压螺钉固定。结果术后随访6~8年,采用Henderson标准评价：19例优,3例良,1例一般,临床疗效优良率为95.65%。X线片提示峡部愈合率为100%。随访中均未发现并发症的发生。结论采用空心加压螺钉内固定＋植骨治疗腰椎峡部裂症患者,可以避免脊柱多节段融合,远期效果好。

Objective To observe the long-term effectiveness of hollow compression nail applied to treat the lumbar spondylolysis without spondylolisthesis.Methods Twenty-three cases of lumbar spondylolysis without spondylolisthesis have been treated with hollow compression nail and bone grafting.The mean age of the group was 34 years（ranging from 19 to 46 years）.Spondylolysis was located at L4 in 7 cases and at L5 in 16 cases.All the patients suffered from severe back pain.During the operation,the presence of the pars interarticular defect was confirmed.The defects were cleared of any fibrous and cartilaginous tissues.The sclerotic bone margins were curetted until bleeding was noted.Autograft harvested from posterior ilium was done.The hollow compression nail was placed into the index vertebra.Results All the patients were followed up from 6 to 8 years.According to Henderson standard,19 patients achieved excellent result,three good result,and one fair result.The excellent and good rate was 95.65%.The X-ray examination showed that the healing rate of spondylolysis was 100%.Conclusion The simple spondylolysis can be treated by the hollow compression nail without spinal fusion.The hollow compression nail is proved to be safe and effective.