椎板钩与椎弓钉固定儿童青少年腰椎峡部裂比较

Lamina hook versus pedicle screw for fixation of lumbar spondylolysis in children and adolescents

[目的]比较椎板钩与椎弓钉固定治疗儿童单纯性双侧腰椎峡部裂的疗效。[方法]回顾性分析2016年1月—2019年1月手术治疗的43例儿童单纯双侧腰椎峡部裂患者的临床资料。根据医患沟通结果,20例行椎板钩内固定,23例行椎弓钉固定。比较两组围手术期、随访及影像结果。[结果]两组患者均顺利手术,椎板钩组手术时间[(79.9±7.8)min vs(103.9±8.6)min,P<0.05]、切口长度[(6.2±0.9)cm vs(7.8±0.8)cm,P<0.05]和术中失血量[(120.8±16.2)ml vs(177.0±12.8)ml,P<0.05]均显著优于椎弓钉组,两组术中透视次数、下地行走时间、切口愈合情况、住院时间的差异均无统计学意义(P>0.05)。两组患者均获随访24个月以上,两组完全负重活动时间的差异无统计学意义(P>0.05),随时间推移,两组VAS评分、ODI指数均显著减少(P<0.05),术后3个月椎板钩组VAS评分[(2.0±0.7)vs(2.4±0.5),P<0.05]、ODI评分[(30.2±6.0)vs(38.7±2.5),P<0.05]均显著优于椎弓钉组,末次随访时两组差异无统计学意义(P>0.05)。影像方面,两组患者术后6个月峡部完全愈合。相应时间点两组椎间隙高度、腰椎前凸角差异均无统计学意义(P>0.05)[结论]椎与椎弓钉固定相比,板钩固定儿童单纯腰椎峡部裂手术创伤小,临床效果优。

[Objective]To compare the clinical efficacy of fixation with laminar hook versus pedicale screw for treatment of simple bilat-eral lumbar spondylolysis in children and adolescent.[Methods]A retrospective study was performed on 43 patients who received surgical treatment for simple bilateral spondylolysis in our department from January 2016 to January 2019.According to doctor-patient communica-tion,20 patients underwent internal fixation with laminar hooks(LH),while the other 23 patients underwent fixation with pedicle screw(PS).The perioperative,follow-up and imaging data were compared between the two groups.[Results]All patients in both groups were successful-ly operated on.The LH group proved significantly superior to the PS group in terms of operation time[(79.9±7.8)min vs(103.9±8.6)min,P<0.05],incision length[(6.2±0.9)cm vs(7.8±0.8)cm,P<0.05]and intraoperative blood loss[(120.8±16.2)ml vs(177.0±12.8)ml,P<0.05].However,there was no statistical significance in the number of intraoperative fluoroscopy,postoperative walking time,incision healing scale and hospital stay between the two groups(P>0.05).Patients in both groups were followed up for more than 24 months,and there was no statis-tical significance in the time to resume full weight-bearing activities between the two groups(P>0.05).As time went on,the VAS and ODI scores significantly decreased in both groups(P<0.05).The LH group was significantly better than the PS group in terms of VAS score[(2.0±0.7)vs(2.4±0.5),P<0.05],ODI score[(30.2±6.0)vs(38.7±2.5),P<0.05]3 months postoperatively,whereas which became not statistically sig-nificant at the latest follow-up(P>0.05).Regarding to imaging,the isthmus was completely healed within 6 months postoperatively in all pa-tients of both groups.There were no statistically significant differences in intervertebral height and lumbar lordosis angle between the two groups at any corresponding time points(P>0.05).[Conclusion]The laminar hook used for fixation of simple lumbar spondylolysis in chil-dren takes advantages of decreasing iatrogenic trauma and improving clinical outcomes over the pedicle screw fixation.