青年腰椎峡部裂手术直接修复治疗与非手术治疗的比较

Comparison of direct repair and conservative treatment in young patients with lumbar spondylolysis

目的回顾性分析直接修复(direct repair,DR)手术和非手术治疗对青年腰椎峡部裂患者的早期效果。方法选择2015年1月~2019年12月在该院就诊的151例青年腰椎峡部裂患者作为研究对象,根据患者治疗方法分为非手术组(79例,传统非手术治疗)和手术组(72例,螺钉固定直接修复),观察两组疼痛VAS评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、12项简式健康调查量表(the 12-items short form health survey,SF-12)得分、缺损间隙距离和缺损愈合率。结果治疗后1个月、3个月、6个月、12个月时,两组患者VAS均较治疗前显著降低(P<0.05),但两组各时间段的VAS评分差异均无统计学意义(P>0.05)。治疗后1个月、3个月、6个月、12个月两组患者ODI指数呈降低趋势,SF-12评分呈升高趋势,差异均有统计学意义(P<0.05);两组患者各时间段的ODI指数和SF-12评分差异均无统计学意义(P>0.05)。治疗后12个月,非手术组腰椎滑脱发生率高于手术组(P<0.05);手术组患者峡部愈合率(75.00%)明显高于非手术组(P<0.05)。手术组并发症发生率高于非手术组(P<0.05)。结论DR手术和非手术治疗对患者腰部、功能障碍和生活质量的短期影响无显著差异,DR手术的并发症高于非手术治疗,但DR手术对抑制病变节段的前移具有积极作用。

Objective To investigate the short-term effect of direct repair(DR)and conservative treatment on young patients with lumbar spondylolysis.Methods A total of 151 young patients with lumbar spondylolysis who were treated in our hospital from January 2018 to December 2019 were selected as the research objects.According to the treatment methods,the patients were divided into non operative group(n=79,traditional conservative treatment)and the operative group(n=72,screw fixation for direct repair).The visual analogue score(VAS),Oswestry disability index(ODI),the 12-items short form health survey(SF-12)and clinical symptoms of the two groups were observed.The incidence of lumbar spondylolisthesis and the rate of defect healing were also detected.Results VAS of the two groups 1 month,3 months,6 months,12 months after the operation were significantly lower than those before operation(P<0.05),but there was no significant difference in VAS scores of the two groups 1 month,3 months,6 months,12 months(P>0.05).ODI of the two groups 1 month,3 months,6 months and 12 months after the operation showed a decreasing trend,but SF-12 showed an increasing trend(P<0.05).There was no significant difference in ODI and SF-12 between the two groups 1 month,3 months,6 months and 12 months after grouping(P>0.05).One year after grouping,the incidence of lumbar spondylolisthesis in the non-surgical group was higher than that in the surgical group(P<0.05).The isthmus healing rate(75.00%)in the operation group was significantly higher than that in the non-operation group(P<0.05).The incidence of complications in the operative group was higher than that in the non operative group(P<0.05).Conclusion There is no significant difference in the short-term effects of DR and conservative treatment on lumbar function,dysfunction and quality of life.The complications of Dr operation are more than those of conservative treatment,but Dr operation has a positive effect on inhibiting the forward movement of lesion segment.