峡部修复联合短节段钉棒内固定治疗中年单纯腰椎峡部裂22例

Isthmus Repair Combined with Short Segmental Pedicle Screw Fixation for the Treatment of Lumbar Spondylolysis in 22 Middle-aged Patients

目的:评价峡部修复联合短节段钉棒内固定治疗中年单纯腰椎峡部裂的临床疗效。方法:对22例反复腰痛的中年单纯腰椎峡部裂患者行峡部修复+短节段钉棒内固定治疗,1年后依据CT骨愈合情况拆除内固定。平均随访64(57~72)月。采用Henderson标准、ODI评分评估术后临床疗效,应用改良Pfirrmann分级评估病椎及邻近节段椎间盘退变情况,观察内固定拆除后病椎滑移程度。结果:Henderson标准评估:优19例,良3例,优良率100%;ODI评分评估:术前平均(76.59%±5.207%),术后平均(4.5%±3.901%),P<0.01。22例患者峡部全部骨愈合,均未出现进展性腰椎滑脱。1例腰4峡部裂患者L5-S1椎间盘术前2级,术后3级,余病变节段及其相邻节段椎间盘信号与术前对比无明显退变。结论:峡部修复+短节段钉棒内固定治疗中年单纯腰椎峡部裂能够解除腰痛、重获峡部骨性连接,具有可早期活动、无进展性椎体滑移、无病椎及邻近节段椎间盘退变、不丢失腰椎活动度等优势,可明显提高患者生活质量。

Objective： to evaluate the clinical efficacy of direct repair of spondylolisthesis combined with postrior short- segment pedicle screw fixation and bone grafting in middle- aged patients after a mean follow- up of 64 months. Methods： 22 middle- aged patients who had symptomatic spondylolisthesis were treated with direct repairing ofspondylolisthesis combined with postrior short- segment pedicle screw fixation and bone grafting. Then,demolition of internal fixation was based on the bone healing after one year. The assessment by independent observers included a structured interview（ Oswestry questionnaire[ODI]）,Henderson criteria,MRI and The degree of vertebral slipping. Results： 19 of 22 patients were excellent,and 3 of 22 patients were good according to Henderson criteria. The ODI between pre- operation with averaged（ 76. 59% ± 5. 207%） and post- operation with averaged（ 4. 5% ± 3. 901%） were significantly different（ P 〈 0. 01）. All of the isthmic vertebra occurs no slipped. The intervertebral disc above or blow the isthmic vertebra presented no degeneration except one that the disc of L5- S1 degenerated of a man who was 55 y with spondylolisthesis of L4. Conclusion： Direct repair of spondylolisthesis combined with postrior short- segment pedicle screw fixation and bone grafting is a effective management for spondylolisthesis in middle- aged patient. It can not only relief the Low back pain but also repair the defect of isthmic. This method has advantage of having activities early,no progressive vertebral slipped,non- vertebral and adjacent segment disc degeneration,retaining the lumbar mobility and so on; significantly improving the quality of life of the patients.