后路复位技术治疗急性重度创伤性腰椎滑脱症的疗效分析

Posterior reduction for treatment of acute severe traumatic lumbar spondylolisthesis

目的总结后路复位技术治疗急性重度腰椎滑脱症的复位技巧及疗效。方法回顾性分析自2010年6月至2018年12月郑州市骨科医院脊柱外科采用后路复位技术治疗的急性重度创伤性腰椎滑脱症12例患者资料。男7例,女5例;年龄(25.7±1.8)岁;L4滑脱4例,L5滑脱8例;滑脱程度根据Meyerding分级:Ⅲ度7例,Ⅳ度4例,Ⅴ度1例;术前神经功能按照美国脊髓损伤协会(ASIA)分级:B级6例,C级4例,D级2例。12例患者均行后路椎弓根螺钉复位内固定和椎间植骨融合术。记录患者的手术时间、术中失血量及并发症的发生情况。手术前、后通过疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评估临床疗效,ASIA分级评价神经功能。X线、CT平扫及重建观察内固定及植骨愈合情况。结果所有患者术后随访(18.5±2.1)个月。手术时间为(165.7±42.3)min,出血量为(497.7±75.3)mL。术后2周及末次随访时VAS评分[(2.7±0.3)、(1.8±0.2)分]、ODI(18.2%±2.3%、14.5%±2.6%)均较术前[(8.5±0.6)分、72.3%±12.3%]降低,差异均有统计学意义(P<0.05),但术后2周和末次随访时比较差异均无统计学意义(P>0.05)。末次随访时X线及CT检查显示内固定位置良好、植骨融合充分。滑脱Meyerding级:0度10例,Ⅰ度2例;末次随访时神经功能ASIA分级:C级2例,D级3例,E级7例。2例患者术后手术切口延迟愈合,对症处理后痊愈。随访期间未见内固定松动、拔出等并发症发生。结论后路复位技术治疗急性重度创伤性腰椎滑脱,能够有效恢复滑脱椎体序列,重建脊柱稳定性,疗效满意。

Objective To evaluate the clinical effects of posterior reduction in the treatment of acute severe traumatic lumbar spondylolisthesis.Methods A retrospective study was conducted to analyze the clinical data of 12 patients with acute severe traumatic lumbar spondylolisthesis who had been treated by posterior reduction at Department of Spinal Surgery,Zhengzhou Orthopaedic Hospital from June 2010 to December 2018.There were 7 males and 5 females with an age of(25.7±1.8)years.The spondylolisthesis was at L4 in 4 cases and at L5 in 8 cases,and gradeⅢin 7 cases,gradeⅣin 4 cases and gradeⅤin 1 case according to the Meyerding classification.By the American Spinal Injury Association(ASIA)grading,the preoperative neurological function was at level B in 6 cases,at level C in 4 cases,and at level D in 2 cases.All the 12 patients underwent posterior reduction and internal fixation with pedicle screws,as well as intervertebral bone graft fusion.Operation time and intraoperative blood loss were recorded.Clinical efficacy was evaluated by visual analogue scale(VAS)and Oswestry disability index(ODI)before and after surgery,and neurological function was evaluated by ASIA grading.X-ray,CT plain scan and reconstruction were used to observe internal fixation and bone grafting.Results All patients were followed up for(18.5±2.1)months.The operation time was(165.7±42.3)min and the blood loss(497.7±75.3)mL.The VAS pain scores[(2.7±0.3)points and(1.8±0.2)points]and ODIs(18.2%±2.3%and 14.5%±2.6%)at 2 weeks after operation and at the last follow-up were significantly lower than the preoperational values[(8.5±0.6)points and 72.3%±12.3%](P<0.05),but there was no statistically significant difference between 2 weeks after operation and the last follow-up(P>0.05).At the last follow-up,X-rays and CT scans showed good fixation and adequate bone grafting;the spondylolisthesis was grade 0 in 10 cases and grade I in 2 cases;the ASIA level of neurological function was C in 2 cases,D in 3 cases,and E in 7 cases.Healing of surgical incision was delayed in 2 patients but responded to symptomatic treatment.Follow-ups observed no such complications as loosening or pulling out of internal fixation.Conclusion In the treatment of acute severe traumatic lumbar spondylolisthesis,posterior reduction can effectively restore the spondylolisthesis sequence and restore spinal stability,leading to satisfactory curative outcomes.