椎弓根钉钩对青少年腰椎峡部裂的功能影响

Effect of Pedicle Screw Hook on Function of Adolescent Lumbar Spondylolysis

目的探讨椎弓根钉钩系统治疗青少年腰椎峡部裂的临床疗效。方法回顾性分析自2008年3月—2016年12月共收治28例累及腰4或(和)腰5节段的青少年双侧峡部裂患者,均行椎弓根螺钉钉钩固定、自体髂骨植骨修复。根据Pfirrmann分类,其椎间盘退变为Ⅰ、Ⅱ…Ⅴ相应赋值为1、2…5,回顾性分析患者的临床和影像学资料。结果男性19例,女性9例;平均年龄(21.6±2.4)岁(16~25岁),平均随访(23.0±9.8)个月(12~46个月)。双节段5例,单节段23例(L4 8例,L5 15例)。超过12个月峡部未愈合共5个节段(5/33),其他节段峡部均愈合,愈合平均时间(6.8±2.1)个月(3~12个月)。末次随访时临床症状完全或部分缓解者为25例,术前、末次随访时L4/5、L5/S1各节段椎间隙活动度分别为(9.2±2.8)°、(8.4±2.3)°、(10.5±3.1)°、(9.1±3.1)°。术前、末次随访时L4/5、L5/S1各节段椎间盘退变分别为(0.9±0.4)°、(1.1±0.5)°,(1.1±0.3)°、(1.4±0.4)°。患者术后伤口无感染,随访期间未见内固定松动、断裂。结论椎弓根钉钩系统固定修复青少年峡部裂患者可获得良好的临床效果,且可维持相应节段的椎间隙功能。

Objective To explore the clinical efficacy of pedicle screw hook system in the treatment of lumbar spondylolysis in adolescents.Methods Retrospective analysis of 28 adolescents patients with bilateral lumbar 4 or(and)lumbar 5 segmental involvement in all patients who had undergone pedicle screw fixation and autologous iliac bone graft repair was performed between March 2008 and December 2016.According to the Pfirrmann classification,the disc degeneration of I,II,...V was assigned 1,2,...5,and the clinical and imaging data of the patients were retrospectively analyzed.Results It was included 19 males and 9 females,with average aged as(21.6±2.4)years(16~25 years),followed up time for(23.0±9.8)months(12~46 months).There were 5 cases with double segments and 23 cases with single segments(8 cases with L4 and 15 cases with L5).Over a 12 month period,there were 5 segments(5/33)did not heal in the isthmus.The rest of the isthmus had all healed and the healing time was(6.8±2.1)months(3~12 months).At the last of follow-up time,there were 25 patients with complete or partial remission with clinical symptoms.The L4/5,L5/S1 intervertebral activity at the time of preoperative and final follow-up was(9.2±2.8)°,(8.4±2.3)°,(10.5±3.1)°,and(9.1±3.1)°,respectively.The degeneration of L4/5,L5/S1 intervertebral disc before and the final followup was(0.9±0.4)°,(1.1±0.5)°,(1.1±0.3)°,(1.4±0.4)°,respectively.There was no infection after surgery of the patients.No loosening and fracture of the internal fixation was appeared during follow-up period.Conclusion The pedicle screw hook system fixation for the repair of adolescent patients with spondylolysis can obtain good clinical results,and can maintain the corresponding segments of intervertebral space function.