采用临时短节段椎弓根螺钉固定联合髂骨植骨治疗青少年腰椎椎弓崩裂症的临床观察

Application of temporary short segment pedicle screws combined with transverse fixation for lumbar spondylolysis

目的观察并评价临时短节段椎弓根螺钉固定联合髂骨植骨治疗青少年腰椎椎弓崩裂症的临床疗效。方法回顾性分析2016年8月至2018年12月因腰椎峡部崩裂症42例患者,对30例平均年龄为24.4岁符合标准的患者采取本手术方法。采用全椎弓根螺钉固定联合横连装置进行崩裂的峡部椎体和下位椎体进行坚强固定。对崩裂的峡部进行瘢痕清理和硬化骨处理;最后取自体髂骨进行峡部修补。术后定期随访,待峡部植骨融合后再次给予内固定取出,恢复固定节段活动度。行X线及CT检查,确定其峡部骨性愈合。待峡部融合后再次取出内固定装置,恢复固定节段活动,进行腰椎动力位片检查评估,测量固定节段的活动度,与术前同节段活动度进行对比。同时分别在手术前、手术固定1年时及内固定取出后1年行腰椎MRI检查,并采用modic分级及pfirrmann分级标准来观察固定节段椎间盘及椎体终板的变化,观察固定节段相应椎体的终板及椎间盘的变化。结果完整随访30例,平均随访时间24(18~36)个月;平均手术时间为107 min;平均出血量为126 ml;平均融合时间为13个月;融合率为100%。所有患者原有下腰痛症状消失,所有患者X线及CT片均提示峡部融合。内固定装置取出后,对患者进行腰椎过伸过屈位X线片检查,动力位片显示固定阶段活动度保存良好,活动度保留率为88.5%。腰椎MRI显示,16例患者固定阶段终板modic改变呈正变化,14例患者无变化,固定阶段椎间盘组织无明显退变变化。结论临时短节段椎弓根螺钉联合横连装置固定是一种治疗腰椎峡部裂简便、有效的方法,固定坚强、融合率高;且临时短节段坚强固定并不会加速固定节段椎间盘退变及临近节段的退变。

Objective To observe the effect of method for juvenile lumbar spondylolisthesis,and evaluate its clinical efficacy by retrospective study.Methods Forty-two patients with spondylolysis diagnosed and treated in Department of Spine Surgery,Xi'an Honghui Hospital from August 2016 to December 2018 were selected for inclusion and exclusion.Among them,there were 30 patients who met the criteria were treated,The average age was 24.4 years,followed up regularly postoperatively,and underwent X-ray and CT examination to determine their isthmic bone healing.The whole pedicle screw joint cross connect device was adopted for the spondylolysis of vertebral body.The scar was of the spondylolysis cleaned.The isthmus was repaired with bone from ilium after hardening processing.The patients were followed up regularly.After fusion of isthmus graft bone,the internal fixation was given out to restore mobility of the fixed segment,and the internal fixation device was removed to restore the fixed segmental mobility.Lumbar dynamic radiography was performed to measure the fixed segmental mobility and compare it with that of the same segmental mobility before surgery.Meanwhile,lumbar MRI examination was performed before surgery,one year after surgical fixation and one year after internal fixation was removed.Modic grading and pfirrmann grading criteria were used to observe the changes of fixed segmental intervertebral disc,vertebral endplate,and the influence of temporary fixation on fixed vertebral endplate and intervertebral disc.Results A total of 30 patients were followed up for an average of 24(18-36)months.The average operation time was 107min;the average blood loss was 126 ml;and the average fusion time was 13 months.The fusion rate was 100%.The original low back pain symptoms disappeared in all patients;and the X-ray and CT images of all patients suggested isthmus fusion.After the internal fixation device was removed,the patients were examined by lumbar over-extension and over-flexion X-ray.The dynamic radiograph showed that the activity was well preserved in the fixed stage.The retention rate of activity was 88.5%.Lumbar MRI showed that modic change of endplate was positively changed in 16 patients at the fixation stage,while no change was observed in 14 patients,and no significant degeneration of intervertebral disc tissue was observed at the fixation stage.Conclusion Temporary short segment pedicle screws with transverse fixation is a simple and effective method to treat lumbar spondylolysis.The temporary short segment rigid fixation will not accelerate the disc degeneration of the fixed segment and adjacent segment.