患椎钉棒固定峡部植骨治疗青少年腰椎峡部裂

Rod-screw fixation of the affected vertebra combined with bone autografting of the pars defect for lumbar isthmic spondylolysis in adolescent

[目的]评价患椎钉棒固定峡部植骨治疗青少年腰椎峡部裂的临床疗效。[方法]2013年5月—2016年7月,本科采用患椎钉棒固定峡部植骨治疗青少年腰椎峡部裂31例,均为男性;年龄17~29岁,主要症状为腰痛。评价临床与影像结果。[结果]所有患者均顺利完成手术,术中无神经、血管损伤等严重并发症,手术时间(109.10±15.12)min,术中出血量(133.55±58.12)ml。31例患者均获随访,随访时间13~35个月,平均(17.65±4.22)个月,随时间推移,ODI和VAS评分显著降低(P<0.05)。影像方面,随时间推移,LL显著减少(P<0.05);峡部连接率显著增加(P<0.05)。随访过程中无内固定松动、断钉断棒。末次随访时所有患者均获得椎弓峡部骨性愈合。[结论]对青少年单纯腰椎峡部裂患者,患椎钉棒固定峡部植骨是一种简单、效果确切的手术方式。

[Objective]To evaluate the clinical outcomes of rod-screw fixation of the affected vertebra combined with bone autografting of the pars defect for lumbar isthmic spondylolysis in adolescents.[Methods]From May 2013 to July 2016,a total of 31 patient who all were male and aged from 17 to 29 years with the main symptom of lumbago,underwent abovementioned surgical procedures for lumbar isthmic spondylolysis in our department.The clinical and imaging consequences were evaluated.[Results]All patients were successfully operated on without serious complications such as nerve and vascular injuries,whereas with operative time of(109.10±15.12)min,and the intraoperative blood loss of(133.55±58.12)ml.As time went during the follow-up lasted for 13~35 months,with an average of(17.65±4.22)months,the ODI and VAS scores decreased significantly(P<0.05).In terms of imaging evaluation,the lumbar lordosis(LL)decreased significantly(P<0.05),whereas the isthmic union ratio increased significantly over time(P<0.05).No loosening or breaking of the rod-screw system was noticed during follow-up in anyone of them,whereas bony union of the isthmus was achieved in all patients at the last followup.[Conclusion]This rod-screw fixation of the affected vertebra combined with bone autografting of the pars defect is a simple and effective surgical method for lumbar isthmic spondylolysis in adolescents.