急性单侧腰椎峡部裂保守治疗后骨愈合失败的相关因素

Related factors of bone healing failure after conservative treatment of acute unilateral lumbar spondylolysis

目的探讨急性单侧腰椎峡部裂(lumbar spondylolysis,LS)保守治疗后骨愈合失败的相关因素。方法选择2018年1月~2021年6月在本院接受保守治疗的96例急性单侧LS患者资料进行回顾性分析,翻阅患者资料,记录患者骨愈合情况、性别、年龄、病程、病理阶段、对侧情况、病变椎体、隐性脊柱裂、治疗前VAS评分、ODI指数等资料。观察骨愈合和骨不愈合患者的临床资料差异,并观察影响骨愈合的风险因素。结果保守治疗后共有37例患者骨愈合失败,发生率为38.54%。LS不愈合患者的年龄和病程均高于骨愈合组,差异有统计学意义(P<0.05)。男性、病理阶段为进展期、对侧骨缺损、病变椎体为L 5的患者不愈合发生率显著升高(P<0.05)。多因素Logistic回归分析显示,L 5椎体、对侧骨缺损、进展期LS是影响LS保守治疗后骨不愈合的风险因素(P<0.05)。结论进展期LS、L 5椎体病变和对侧骨缺损,是急性单侧LS患者骨不愈合的风险因素,应考虑直接进行手术治疗,以尽早达到骨性愈合。

Objective To investigate the related factors of bone healing failure after conservative treatment of acute unilateral lumbar spondylolysis(LS).Methods The data of 96 patients with unilateral acute LS who received conservative treatment in our hospital from January 2018 to June 2021 were analyzed retrospectively.The patients’data were reviewed,and the bone healing,gender,age,course of disease,pathological stage,contralateral condition,pathological segment,occult spina bifida,VAS,ODI before treatment and other data were recorded.The difference in clinical data between bone healing and non bone healing patients was observed,and the risk factors affecting osteosynthesis were observed.Results After conservative treatment,bone healing failed in 37 patients,and the incidence of non bone healing was 38.54%.The age and course of LS unhealed patients were significantly higher and longer than those in bone healing group(P<0.05).The incidence of nonunion was significantly higher in men,pathological stage,progressive stage,contralateral bone defect and diseased segment L 5(P<0.05).Multivariate logistic analysis showed that L 5 segment,contralateral bone defect and advanced LS were the risk factors of bone nonunion in LS conservative treatment(P<0.05).Conclusion Advanced stage,L 5 segment lesion and contralateral bone defect are the risk factors of bone nonunion in patients with acute unilateral ls.Direct surgical treatment should be considered in order to achieve bone healing as soon as possible.