短节段固定椎间融合手术治疗青壮年腰椎峡部不连性滑脱临床疗效观察

Short segment screw-rod fixation system with intervertebral fusion cage for lumbar isthmic spondylolisthesis of young adults

目的探讨短节段固定椎间融合手术治疗青壮年腰椎峡部不连性滑脱的方法及疗效。方法回顾性分析自2009年1月至2016年1月于解放军第五医院采用短节段固定椎间融合手术治疗的39例青壮年腰椎峡部不连性滑脱患者的临床资料。记录患者围术期切口愈合和并发症发生情况;随访12~24个月,比较患者治疗前及治疗后的日本骨科协会(JOA)评分、视觉模拟评分法(VAS)评分、滑脱率、滑脱角、椎间隙高度,以及腰椎融合情况。结果所有患者术后切口均Ⅰ期愈合,未出现感染等并发症。患者术后12个月的腰痛VAS评分、腿痛VAS评分、JOA评分均较治疗前改善,差异均有统计学意义(P<0.05)。患者末次随访时的腰椎椎体滑脱率、滑脱角及椎间隙高度均较治疗前改善,差异均有统计学意义(P<0.05)。X线和CT检查显示融合位置均获骨性愈合,无继发性椎体滑脱和邻近节段退行性变,无下肢神经症状加重,无椎弓根钉和融合器断裂或松动。结论短节段固定椎间融合手术治疗青壮年腰椎峡部不连性滑脱安全、有效,滑脱腰椎可基本复位,腰椎滑脱角明显减小,椎间隙高度基本恢复正常。

Objective To investigate the effect of short segment screw-rod fixation system with intervertebral fusion cage for lumbar isthmic spondylolisthesis of young adults.Methods A retrospective study was performed on 39 cases of young adult patients with lumbar isthmic spondylolisthesis who underwent short segment screw-rod fixation system with intervertebral fusion cage.The wound healing and complications were recorded during perioperative period.Patients were followed up for 12-24 months,the Japanese Orthopaedic Association(JOA)score,visual analogue scale(VAS)score,slippage rate,slippage angle,height of the intervertebral space and lumbar fusion were compared before and after the treatment.Results All patients obtained primary healing of incision without complications of incision infection.The lumbago VAS score,leg pain VAS score and JOA score of the 12 months after surgery were all better than those before the treatment,and the difference was statistically significant(P<0.05).The slippage rate,slippage angle and the height of the intervertebral space in the last follow-up visit were improved compared with those before the treatment(P<0.05).X-ray films and CT showed bone fusion in the area.During follow-up,no secondary lumbar spondylolisthesis,adjacent segment degeneration,no complication of lower limbs nerve symptom or loosening or breaking of internal fixator were found.Conclusion Postoperative lumbar spondylolisthesis is basically reset,the slippage angle is significantly reduced,and the height of the intervertebral space is recovered basically.Short segment screw-rod fixation system with intervertebral fusion cage is a reliable and effective treatment for isthmic spondylolisthesis of young adults.