“U”形棒单节段固定结合峡部植骨治疗单纯腰椎峡部裂的疗效

The Clinical Observation of U-shaped Rod Combined with Isthmus Bone Graft and Single-segment Fixation in the Treatment of Simple Lumbar Spondylolysis

目的研究“U”形棒单节段固定结合峡部植骨治疗单纯腰椎峡部裂的临床疗效,分析术后峡部融合及远期效果。方法回顾性分析2017年1月至2019年12月中国科学院大学深圳医院采用“U”棒单节段固定结合峡部植骨治疗的37例单纯腰椎峡部裂患者,男26例,女11例;年龄17~42岁,平均(26.54±6.32)岁。记录手术时间、术中出血量、术后引流量等,比较术前及术后的疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI),观察术后峡部融合情况。结果术后随访24~60个月,平均(37.46±9.71)个月。患者术后下腰痛VAS较术前降低,差异有统计学意义(P<0.05);术后ODI较术前改善,差异有统计学意义(P<0.05);峡部融合率约为82.43%,融合时间(8.82±3.63)个月。末次随访时患者均未继发腰椎滑脱及邻近节段退变,内固定无断裂、松动等。结论“U”形棒单节段固定结合峡部植骨治疗单纯腰椎峡部裂,术式简单、安全性高,手术时间短、切口小、出血少、并发症少,术后腰痛缓解明显、腰椎功能恢复好、峡部骨性融合率高、内固定牢固,疗效确切。

Objective To study the clinical efficacy of a U-shaped rod combined with isthmus bone graftting and single-segment fixation in the treatment of simple lumbar spondylolysis.To analyze the postoperative isthmus fusion and long-term effect.Methods Thirty-seven simple lumbar spondylolysis patients treated with a U-shaped rod combined with isthmic bone grafting and single-segment fixation in University of Chinese Academy of Sciences-Shenzhen Hospital from January 2017 to December 2019 were analyzed retrospectively,including 26 males and 11 females.The age ranged from 17 to 42 years with an average of(26.54±6.32)years.The duration of surgery,intraoperative blood loss and postoperative drainage volume were recorded.The preoperative visual analogue scale(VAS)and Oswestry disability index(ODI)were compared to postoperatively.The fusion of isthmus was observed.Results The patients were followed for 24~60 months postoperatively,with an average of(37.46±9.71)years.The VAS of patients with postoperative low back pain was lower than preoperatively,and the difference was statistically significant(P<0.05).The ODI after operation was significantly improved compared with that before operation,and the difference was statistically significant(P<0.05).The bony fusion rate was 82.43%,and the duration of fusion was(8.82±3.63)months.At the final follow-up,none of the patients had secondary lumbar spondylolisthesis or adjacent segmental disc degeneration,there were no complications such as rupture or loosening of internal fixation.Conclusion In the treatment of simple lumbar spondylolysis,a U-shaped rod combined with isthmic bone grafting and single-segment fixation is characterized by a short and simple operation with a small incision,safety,little bleeding and few complications.The surgery relieves lumbago,lumbar function is recovered,the isthmic bony fusion rate is high,and the internal fixation is firm.Therefore,the surgery has definite therapeutic effect.