ISOBAR TTL动态固定与峡部植骨治疗单纯腰椎峡部裂或伴Ⅰ度滑脱的效果分析

Effect of ISOBAR TTL dynamic fixation and isthmus bone grafting in the treatment of lumbar spondylolysis or degree Ⅰ spondylolisthesis

目的探讨ISOBAR TTL动态固定与峡部植骨治疗单纯腰椎峡部裂或伴Ⅰ度滑脱的临床效果。方法纳入2015年4月~2017年4月本院收治的49例腰椎峡部裂患者,均采用ISOBAR TTL动态固定与峡部植骨治疗,平均随访(31.24±2.7)个月。记录手术完成情况,术后随访并评价手术效果。结果49例患者手术耗时(118.86±15.78)min,平均失血量(156.87±26.32)ml,住院时间(10.87±2.68)d;术后1个月、3个月、末次随访的ODI指数、疼痛VAS评分均显著低于术前,差异有统计学意义(P<0.05);手术优良率为95.91%,术后6个月峡部断端的骨性融合率85.71%,术后1年融合率97.96%,仅发生1例慢性腰痛,无邻近节段退变(Adjacent segment degeneration,ASD)、螺钉断裂、感染等严重并发症出现。结论ISOBAR TTL动态固定与峡部植骨能有效改善单纯腰椎峡部裂或伴Ⅰ度滑脱患者疼痛及功能障碍,峡部断端骨性融合率高,还能有效避免ASD发生。

Objective To study the clinical effect of ISOBAR TTL dynamic fixation and isthmus bone grafting in the treatment of lumbar spondylolysis or degreeⅠspondylolisthesis.Methods From April 2015 to April 2017,49 patients with spondylolysis were treated with ISOBAR TTL dynamic fixation and isthmic bone grafting,with an average follow-up of(31.24±2.7)months.The results of the operation were recorded,followed up and evaluated.Results All the 49 patients underwent surgery.The average time was(118.86±15.78)min,the average blood loss was(156.87±26.32)mL,the hospital stay was(10.87±2.68)d.At 1 month,3 months after operation and the last follow-up,the ODI index and pain VAS scores were significantly lower than before surgery,the difference was statistically significant(P<0.05).The excellent rate of surgery was 95.91%,the rate of osseous fusion at the isthmus was 85.71%at 6 months after operation,and the rate of fusion at 1 year after operation was 97.96%.Only one case of chronic low back pain was observed,no adjacent segmental degeneration(ASD),screw fracture,infection and other serious complications symptom were observed.Conclusion ISOBAR TTL dynamic fixation and isthmus bone grafting can effectively improve the pain and dysfunction of patients with simple lumbar spondylolysis or with degree I spondylolisthesis.The rate of bone fusion at the isthmus is high,and it can effectively avoid ASD.