采用U形钛棒固定系统的节段内固定与峡部植骨治疗青壮年腰椎峡部裂

EFFECTIVENESS OF U-SHAPE TITANIUM SCREW-ROD FIXATION SYSTEM WITH BONE AUTOGRAFTING FOR LUMBAR SPONDYLOLYSIS OF YOUNG ADULTS

目的 探讨采用U形钛棒固定系统的节段内固定与峡部植骨治疗青壮年腰椎峡部裂的疗效。 方法 2008年1月－2011年12月，采用U形钛棒固定系统的节段内固定与峡部植骨治疗32例青壮年腰椎峡部裂男性患者。患者年龄19～32岁，平均22岁。病程3～24个月，平均14个月。峡部裂位于L3 2例，L4 10例，L5 20例。术前疼痛视觉模拟评分（VAS）为（8.0 ± 1.1）分，Oswestry功能障碍指数（ODI）为（75.3 ± 11.2）分。 结果 手术时间80～120 min，平均85 min；术中出血量150～250 mL，平均210 mL。术后切口均Ⅰ期愈合，无感染、神经症状加重等并发症发生。患者均获随访，随访时间12～24个月，平均14个月。术后3个月VAS、ODI评分分别为（1.0 ± 0.5）、（17.6 ± 3.4）分，均较术前显著改善（t=30.523，P=0.000；t=45.312，P=0.000）。X线片及CT复查示峡部裂均获骨性愈合，愈合时间6～12个月，平均9个月；随访期间无继发性椎体滑脱和邻近节段退变，无椎弓根螺钉及U形钛棒断裂或松动发生。 结论 采用U形钛棒固定系统的节段内固定与峡部植骨治疗青壮年腰椎峡部裂，具有创伤小、保留了腰椎节段运动功能的特点，是一种安全可靠的术式。

Objective To investigate the effectiveness of U-shape titanium screw-rod fixation system with bone autografting for lumbar spondylolysis of young adults. Methods Between January 2008 and December 2011, 32 patients with lumbar spondylolysis underwent U-shape titanium screw-rod fixation system with bone autografting. All patients were male with an average age of 22 years （range, 19-32 years）. The disease duration ranged from 3 to 24 months （mean, 14 months）. L3 was involved in spondylolysis in 2 cases, L4 in 10 cases, and L5 in 20 cases. The preoperative visual analogue scale （VAS） and Oswestry disability index （ODI） scores were 8.0 ± 1.1 and 75.3 ± 11.2, respectively. Results The operation time was 80-120 minutes （mean, 85 minutes）, and the blood loss was 150-250 mL （mean, 210 mL）. Primary healing of incision was obtained in all patients without complications of infection and nerve symptom. Thirty-two patients were followed up 12-24 months （mean, 14 months）. Low back pain was significantly alleviated after operation. The VAS and ODI scores at 3 months after operation were 1.0 ± 0.5 and 17.6 ± 3.4, respectively, showing significant differences when compared with preoperative ones （t=30.523, P=0.000;t=45.312, P=0.000）. X-ray films and CT showed bone fusion in the area of isthmus defects, with the bone fusion time of 6-12 months （mean, 9 months）. During follow-up, no secondary lumbar spondyloly, adjacent segment degeneration, or loosening or breaking of internal fixator was found. Conclusion The U-shape titanium screw-rod fixation system with bone autografting is a reliable treatment for lumbar spondylolysis of young adults because of a high fusion rate, minimal invasive, and maximum retention of lumbar range of motion.