计算机辅助微创脊柱外科技术结合经椎板拉力螺钉峡部固定植骨治疗单纯腰椎峡部裂

Computer Assisted Minimal Invasive Spine Surgery with translaminar lag screw fixation for simplespondylolysis in young patients

目的探计算机辅助微创（CAMISS）结合经椎板拉力螺钉峡部固定植骨治疗年轻患者堆纯腰椎峡部裂的临床效果。方法自2001年2月至2013年7月共治疗年轻单纯腰椎峡部裂患者52例，分别采川椎弓根钉-椎板钩同定植骨（椎弓根钉-钩组-35例）、经椎板拉力螺钉峡部固定植骨（峡部螺钉组，8例）及CAMlSS结合经柞板拉力螺钉峡部固定植骨（CAMISS峡部螺钉组，9例）治疗，比较3组患者的手术时间、术后出血量、术后住院时间、视觉模拟评分法（VAS）、峡部融合率及Mac Nab评价。结果椎弓根钉-钩组和CAMISS峡部螺钉组的手术时间[（135．1±29．2）min、（146．7±32．4）min]和术后住院时问[（6．3±1．8）d、（4．2±0．8）d]短于峡部螺钉组[（179．8±44．2）min、（9．0±3．2）d]，蔗蚌均有统计学意义（P〈0．05），而椎弓根钉-钩组和CAMISS峡部螺钉组间比较差件均尢统计学意义（P〉0．05）。出血量方面：CAMISS峡部螺钉组[（103．3±80．0）mL]〈椎弓根钉-钩组[（282．2±l34．6）mL]〈峡部螺钉组[（398．2±119．5）mL]，两两比较差异均有统计学意义（P〈0．05）.3组间手术前、后VAS评分差异均无统计学意义（P〉0．05），但术后均较术前改善，差异有统计学意义（P〈0．05）。3组问的融合率和MacNab评价比较差异均兀统计学意义（P〉0．05）。结论经椎板拉力螺钉峡部固定及椎弓根钉钩技术均足治疗年轻单纯腰椎峡部裂患者的有效手段，CAMISS结合经椎板拉力螺钉峡部㈣定使此项技术得到重要改进。

Objective To evaluate the clinical t,utcomes of Computer Assisted Minimal Invasive Spine Surgery （CAMISS） with translaminar lag screw fixation in the treatment of spondylolysis in young pa- tients. Methods From 2001 to 2013, 52 young patients with spondylolysis received surgery in our de- partment. Of them, 35 were treated hy pedicle screw laminar hook fixation, 8 by translaminar lag screw fix-ation, and 9 by CAMISS with translaminar lag screw fixation. The 3 groups were compared in terms of oper-ation time, intraoperative blood loss, postoperative hospital stay, visual analogue scale （VAS）, fusion rate and Mac Nab evaluation. Results The operation time and hospital stay in the groups of pedicle screw laminar hook fixation aml CAMISS （ 135. 1 ± 29.2 min versus 146. 7 ± 32.4 rain; 6.3 ± 1.8 d versus 4.2 ± 0.8 d） were significantly shorter than in the group of translaminar lag screw fixation （179.8 ± 44.2 min and 9.0 ± 3.2 d） （ P 〈 0. 05）. However, there were no such significant differences between the groups of pedicle screw laminar hook fixation and CAMISS （ P 〉 0.05） . As for blood loss, the group of CAMISS （103.3 ± 80. 0 ml,） 〈 the group of pedicle serrw laminar hook fixation （282.2 ± 134.6 mL） 〈 the group of translaminar lag screw fixation （398.2± 119.5 mL）, with significant ditTerences between groups （P 〈 0.05 ） . There were no significant differences between the 3 groups regarding the preoperative and postoper-ative VAS scores （ P 〉 0.05）, but there were significant differences between the preoperative VAS scores and the postoperative ones （ P 〈 0.05）. There were no significant differences between the 3 groups in the fusion rate or Mac Nab evaluation （ P 〉 0. 05） . Conclusions Translaminar lag screw fixation and pedicle screw-laminar hook fixation are effective in treatment of spondylolysis in young patients. CAMISS substantially improves translaminar lag screw fixation.