双螺纹空心加压螺钉内固定结合峡部植骨治疗青少年腰椎峡部裂

Double thread hollow compression screws with isthmic bone grafting for adolescent lumbar spondylolysis

目的探讨青少年腰椎峡部裂采用局部植骨辅助双螺纹空心加压螺钉内固定治疗的临床疗效。方法回顾性分析自2007-01—2009-12采用双螺纹空心加压螺钉结合峡部植骨治疗的56例青少年腰椎峡部裂。比较手术前后Oswestry功能障碍指数（ODI）和疼痛视觉模拟评分（VAS）,应用椎间盘内的相对信号强度评价椎间盘退变情况。结果本组手术时间平均65（45~75）min,术中出血量平均80（60~150）ml。所有患者均获得至少60个月随访。CT检查显示峡部裂均获得骨性愈合,愈合时间平均11（10~12）个月。术后12个月时ODI指数为（16.3±2.9）%,较术前明显改善,差异有统计学意义（t=29.986,P〈0.001）。术后12个月时VAS评分（0.9±0.4）分,较术前明显降低,差异有统计学意义（t=46.238,P〈0.001）。术后60个月时椎间盘内的相对信号强度为0.83±0.11,与术前比较差异无统计学意义（t=1.213,P=0.741）。结论双螺纹空心加压螺钉内固定结合峡部植骨治疗青少年腰椎峡部裂能保留脊柱运动功能单位,创伤小,愈合率较高。

Objective To investigate the effectiveness of double thread hollow compression screws with isthmic bone grafting for the treatment of adolescent lumbar spondylolysis. Methods Between January 2007 and December 2009, 56 patients with lumbar spondylolysis underwent double thread hollow compression screws with isthmic bone grafting. Oswestry dysfunction index （ODI） and pain visual analogue scale （VAS） before and after surgery were compared. The relative signal intensity was used to evaluate the intervertebral disc degeneration. Results The average time of operation was 65（45-75）min, and the average amount of bleeding was 80（60-150）ml. All patients were followed up for at least 60 months. CT examination showed spondylolysis were healed; the average healing time was 1 l（10-12）months. The ODI index was （16.3＋2.9）% after 12 months of operation, and the difference was statistically significant （t =29.986, P 〈0.001）. At 12 months after operation, the VAS score （0.9＋0.4） was significantly lower than that before operation, and the difference was statistically significant （t =46.238, P 〈 0.001）. Sixty months after operation the relative signal intensity of quantitative measurement of intervertebral disc was 0.83-＋ 0.11, compared with preoperative one the difference was not significant （t =1.213, P =0.741）. Conclusion Double thread hollow compression screws combined with bone graft in the treatment of adolescent isthmic spondylolysis can keep the spine motion function with small trauma and the hizh rate of healinz.