Gillet直接修补技术治疗腰椎椎弓峡部裂(2年随访结果)

Direct repair for treatment of lumbar symptomatic spondylolysis using Gillet technique(2 year follow up)

目的 探讨Gillet直接修补技术治疗腰椎椎弓峡部断裂的适应证和术后疗效。方法 回顾性分析自2007-01—2011-12采用Gillet技术直接修补的双侧腰椎椎弓峡部断裂21例,行后路峡部断裂椎体双侧峡部瘢痕组织切除,椎弓根钉置入＋峡部V形棒内固定＋自体植骨融合术。结果 术后21例均获得随访2~3年,平均2.5年。术前VAS评分（4.8±0.9）分,术后6周（2.1±0.6）分,术后24个月（2.3±0.7）分;术前ODI评分（52.6±8.9）%,术后6周（16.6±1.9）%,术后24个月（14.6±1.6）%。术后6周VAS评分（t=13.780,P〈0.001）、ODI评分（t=19.35,P〈0.001）较术前明显降低;术后24个月ODI评分（t=4.899,P〈0.001）较术后6周明显降低,差异均有统计学意义（P〈0.01）。术后6周VAS评分（t=0.940,P=0.358）与术后24个月比较差异无统计学意义（P〉0.01）。X线片及三维CT显示19个椎体植骨处在术后1年达到骨性愈合,未愈合患者症状也得到明显改善。结论 对于腰椎椎弓峡部断裂患者,可以使用自体植骨＋内固定直接修补峡部断裂处,避免后期腰椎滑脱的发生。

Objective To investigate the indication and results of direct repair for treatment of lumbar symptomatic spondylolysis using Gillet technique. Methods Twenty-one cases of bilateral lumbar spondylolysis treated by Gillet direct repair technique from Jan. 2007 to Dec. 2011 were retrospectively studied. All the patients received posterior lumbar spondylolysis isthmus scar resection, pedical screw instrumentation, V shaped rod fixation and autograft fusion. Results All cases were followed up for 2-3 years after operation, average 2.5 years. VAS scores before and 6 weeks and 24 months after operation were （4.8±0.9）, （2.1±0.6） and （2.3±0.7） respectively. ODI before and 6 weeks and 24 months after operation were （52.6±8.9）%, （16.6±1.9）%, （14,6±1.6）% respectively. VAS（t =13.780,P 〈0.001） and ODI scores （t=19.350,P 〈0.001） of 6 weeks after operation were significandy decreased compared with those before operation. ODI score （t =4.899 ,P 〈0.001） of 2 years after operation was also improved significantly compared with that of 6 weeks after operation There was no significant difference in VAS score（t =0.940, P =0.358） before and 6 weeks after operation. The pars defect attained bony union in X-ray and 3D CT scan one year after operation in 19 cases, symptoms of others also got relieved obviously. Conclusion Patients with lumbar pars defect can be treated by direct repair for the pars with pedicle screw and V-shape rod and bone autograft. This treatment can avoid the occurrence of delayed lumbar spondylolisthesis.