Wiltse入路单侧椎弓根钉棒内固定联合自体髂骨移植治疗单节段腰椎峡部裂的疗效及安全性研究

Efficacy and safety of unilateral pedicle screw rod internal fixation combined with autologous iliac bone transplantation through Wiltse approach in the treatment of single segment lumbar spondylolysis

目的 研究Wiltse入路单侧椎弓根钉棒内固定联合自体髂骨移植治疗单节段腰椎峡部裂的疗效及安全性。方法 选取2019年3月至2020年12月期间武警陕西省总队医院收治的80例单节段腰椎峡部裂患者进行研究,根据随机数表法分为观察组和对照组各40例。两组患者均进行自体髂骨移植治疗,对照组采用正中入路单侧椎弓根钉棒内固定,研究组采用Wiltse入路单侧椎弓根钉棒内固定,比较两组患者的住院时间、手术时间、术后引流量、术中出血量等相关手术指标;比较两组患者术前及术后7 d、3个月和末次随访时的日本骨科协会(JOA)评分、Oswestry功能障碍指数(ODI)评分;比较两组患者术后Frankel分级评定、椎间融合率、植骨融合时间和并发症发生情况。结果 研究组患者术后引流量、术中出血量、手术时间、住院时间分别为(77.9±11.5) mL、(148.3±17.5) mL、(2.32±0.42) h、(8.4±2.4) d,明显短(少)于对照组的(3.64±0.51) h、(269.4±25.4) mL、(121.4±17.8) mL、(14.3±3.1) d,差异有统计学意义(P<0.05);术前,两组患者的JOA评分、ODI评分比较差异均无统计学意义(P>0.05);术后7 d、术后3个月以及末次随访时,两组患者的JOA评分明显升高、ODI评分明显下降,且研究组患者的JOA评分分别为(15.64±0.87)分、(22.73±1.51)分、(24.38±3.05)分,明显高于对照组的(13.01±0.52)分、(18.22±1.03)分、(22.04±2.61)分,术后ODI评分分别为(19.4±3.5)%、(11.3±2.4)%、(8.3±1.6)%,明显低于对照组的(25.7±3.7)%、(17.9±2.8)%、(14.7±2.1)%,差异均有统计学意义(P<0.05);治疗前,两组患者的脊髓神经功能评级比较差异无统计学意义(P>0.05),而治疗后末次随访时,研究组患者的脊髓神经功能明显优于对照组,差异有统计学意义(P<0.05);两组患者的椎间融合率、植骨融合时间比较差异均无统计学意义(P>0.05);研究组患者术后并发症总发生率为5.0%,略高于对照组的2.5%,但差异无统计学意义(P>0.05)。结论 Wiltse入路单侧椎弓根钉棒内固定联合自体髂骨移植治疗单节段腰椎峡部裂可有效降低患者术中出血量、术后引流量、术后疼痛感,改善患者术后腰部运动功能,临床疗效显著且安全性高,值得推广应用。

Objective To study the efficacy and safety of unilateral pedicle screw rod internal fixation combined with autologous iliac bone transplantation through Wiltse approach in the treatment of single segment lumbar spondylolysis. Methods From March 2019 to December 2020, 80 patients with single segment lumbar spondylolysis admitted to Armed Police Shaanxi Provincial Corps Hospital were selected for study. According to the method of random number table, the patients were divided into an observation group and a control group, each with 40 patients. Based on autogenous iliac bone transplantation, the control group applied unilateral pedicle screw rod internal fixation through the median approach, and the study group applied unilateral pedicle screw rod internal fixation through the Wiltse approach. The length of hospital stay, operation time, postoperative drainage volume, intraoperative bleeding, and other related surgical indicators of the patients in the two groups were compared. The Japanese Orthopaedic Association Scores(JOA) and Oswestry dysfunction index(ODI) scores of the two groups were compared before operation, at 7 days, 3 months after operation, and at the last follow-up. Frankel grading, intervertebral fusion rate, bone graft fusion time, and complications were compared between the two groups. Results The postoperative drainage volume, intraoperative bleeding volume,operation time, and length of hospital stay in the study group were(77.9±11.5) mL,(148.3±17.5) mL,(2.32±0.42) h, and(8.4±2.4) d, which were significantly shorter(less) than(3.64±0.51) h,(269.4±25.4) mL,(121.4±17.8) mL, and(14.3±3.1) d in the control group(P<0.05). Before operation, there was no significant difference in JOA score and ODI score between the two groups(P>0.05). At 7 days, 3 months after operation and at the last follow-up, the JOA scores of the two groups increased significantly and ODI scores of the two groups decreased significantly;the JOA scores of the study group were(15.64±0.87) points,(22.73±1.51) points, and(24.38±3.05) points, which were significantly higher than(13.01±0.52) points,(18.22±1.03) points, and(22.04±2.61) points of the control group(P<0.05);the postoperative ODI scores of the study group were(19.4±3.5)%,(11.3±2.4)%, and(8.3±1.6)%, which were significantly lower than(25.7±3.7)%,(17.9±2.8)%, and(14.7±2.1)% of the control group(P<0.05). Before treatment, the spinal nerve function ratings showed no statistically significant difference between the two groups(P>0.05);at the last follow-up after treatment, the spinal nerve function of the patients in the study group was significantly better than that of the control group(P<0.05).The intervertebral fusion rate and fusion time showed no statistically significant difference between the two groups(P>0.05). The total incidence of postoperative complications was 5.0% in the study group and 2.5% in the control group,with no statistically significant difference(P>0.05). Conclusion Unilateral pedicle screw rod internal fixation combined with autogenous iliac bone transplantation through Wiltse approach has a significant effect in the treatment of single segment lumbar spondylolysis, which can effectively reduce the amount of intraoperative bleeding, postoperative drainage, postoperative pain, and improve the lumbar sports function of patients, with a significant clinical effect and high safety. It is worthy of promotion and application.