Surgical treatment of four segment lumbar spondylolysis:A case report

Four-level lumbar spondylolysis is extremely rare.So far,only 1 case has been reported in the literature.CASE SUMMARY A 19-year-old man presented with severe back pain irresponsive to conservative therapies for 2 years.Lumbar radiographs and two-dimensional computed tomography scan showed four segment lumbar spondylolysis on both sides of L2-L5.Lumbar magnetic resonance imaging showed normal signal in all lumbar discs.Because daily activities were severely limited,surgery was recommended for the case.The patient underwent four-level bilateral isthmic repair at L2-L5.During surgery,L2-L5 isthmi were curetted bilaterally,freshened,and then grafted with autologous iliac bone that was bridged and compressed with a pedicular screw connected to a sub-laminar hook by a short rod.The symptoms of back pain almost disappeared.He has been followed-up for 96 mo,and his symptoms have never recurred.Fusion was found in all repaired isthmi 14 mo after surgery according to evaluation of lumbar radiography and computed tomography scan.CONCLUSION We report here 1 case of four-level lumbar spondylolysis that was treated successfully with direct isthmic repair.

Combining Posterolateral Lumbar Fusion and Posterior Lumber Interbody Fusion Surgery for Treating Three-Level Lumber Spondylolysis and Single-Level Spondylolisthesis: Case Report

Lumbar spondylolysis is a relatively common condition that can cause a variety of clinical manifestations related to the lumbar spine. However, multi-level lumbar spondylolysis is rare and accounts for less than 6% of lumbar spondylolysis. We report a case of three-level lumbar spondylolysis with single-level spondylolisthesis. A 47-year-old woman presented to us with low back pain for 9 years that progressively worsened and the pain was exacerbated with standing and walking. She was diagnosed with three-level lumbar spondylolysis at L3-5 and spondylolisthesis at L4. We performed posterolateral lumber fusion (PLF) and posterior lumbar interbody fusion (PLIF) surgery for her. During the same period, pain recovery and fusion rate of the patient were evaluated after surgery. The results were favorable and proved the efficacy of combining PLF and PLIF technique for treatment for three-level lumbar spondylolysis and single-level spondylolisthesis.

Application of a new anatomic hook-rod-pedicle screw system in young patients with lumbar spondylolysis:A pilot study

BACKGROUND The pedicle screw-laminar hook system has strong fixation and is conducive to bone graft fusion for lumbar spondylolysis.However,the current pedicle screwlaminar hook fixation system is not specifically designed for lumbar spondylolysis.AIM To investigate the clinical effects of a new anatomical hook-rod-pedicle screw system in the treatment of lumbar spondylolysis in young adults.METHODS We designed a new anatomic hook-rod-pedicle screw system for young patients with lumbar spondylolysis.The isthmus and the corresponding pedicle screw entry point were exposed through the intermuscular approach.Autogenous iliac bone graft was obtained to bridge the isthmus defect,and then the anatomic hook-rod-pedicle screw system was used to fix the isthmus in 15 young patients.RESULTS At 24 mo follow-up,the visual analogue scale score of low back pain decreased from 6.73±0.88 to 0.73±0.59,and the Oswestry disability index score decreased from 58.20±8.99 to 7.87±4.97.Computed tomography showed bilateral isthmic bone healing in 14 cases and unilateral isthmic bone healing in 1 case.Magnetic resonance imaging showed that the lumbar disc signal of diseased segment and adjacent segments had no change compared with that before surgery.The pain visual analogue scale score of the donor site was 0.20±0.41 at the last follow-up.According to the Modified Macnab score,the excellent and good rate was 100%.CONCLUSION The application of this new anatomical hook-rod-pedicle screw system to treat young patients with lumbar spondylolysis has the advantages of less trauma,a simple operation and satisfactory clinical effects.

Application of 3D printing technique in pedicle screw placement for the lumbar isthmic spondylolisthesis

Objective:To investigate the application value of 3D printing technique in the operation of the lumbar isthmic spondylolisthesis.Methods Totally 48 patients with lumbar isthmic spondylolisthesis treated in our department from January 2015 to April 2017 were selected in the research plan.According to the random digital table method,they were divided into the observation group and the control group,with 25 cases in the observation group and 23 cases in control group.All patients were treated with transforaminal lumbar interbody fusion(TLIF).The control group made the observation group made the operation plan with 3D printing technology,and the operation plan according to the 3D CT reconstruction image.The clinical and imaging results were compared between the two groups、including operation time、intraoperative blood loss and X-ray exposure、complications、preoperative and postoperative ODI and JOA score.Results The accuracy of the screw placement in the observation group was 95.33%,which was significantly higher than those of 84.06%in the control group,the differences were statistically significant(P<0.05).Operation time and X-ray exposure and intraoperative blood loss in observation group were less than those in the control group,the differences were statistically significant(P<0.05).There were no significant differences spondylolisthesis reduction degree、ODI and JOA scores at postoperative different point between groups(P>0.05).Conclusions 3D printing technology is helpful to the development of the lumbar isthmic spondylolisthesis surgical plan,with the advantages of shortening the operation time and X-ray exposure,reducing the blood loss,improving the accuracy of the screw placement.

Vibration Signal Analysis for Detecting Early-Stage Lumbar Spondylolysis Using Synthetic Bone

Bone fractures can be detected by analyzing vibration signals following bone stimulation. This method can also be applied to detect stress fractures, such as spondylolysis. The aim of this study was to investigate whether vibration signal analysis can be used to detect lumbar spondylolysis in synthetic bone. Four synthetic spondylolysis models of the fifth lumbar vertebra (Sawbones, product No. SAW1352-10: Malm&#246;, Sweden) were prepared, with the following conditions: intact, unilateral defect, and bilateral defect. Unilateral defects were created by making an incision of either half the diameter (50% incision) or the entire diameter (100% incision) in length through the pars interarticularis or pedicle. Bilateral defects were created by making an additional incision of half the diameter in length on the opposite side of the defected pars interarticularis or pedicle (50% + 100% incision). Hammering was performed five times on each spinous process of the fixed synthetic bones and vibration signals were measured using an accelerometer attached to the contralateral side of the hammer. Signals were analyzed using fast Fourier transform. The parameters analyzed included the mean power frequency, first power minimum frequency (the minimum value between the first and second peaks), spectral areas of low and high frequency bands, and the relative ratio between the spectral areas of low and high frequency bands. The relative ratio was significantly lower in the 50%, 100%, and 50% + 100% incision conditions compared to the intact condition (p < 0.01), suggesting the potential utility of vibration signal analysis in diagnosing lumbar spondylolysis.

Return to sports activity by athletes after treatment of spondylolysis

AIM:To clarify the efficacy of conservative and surgical treatment of spondylolysis in athletes.METHODS:PubMed was used to perform a search of the literature for studies published during the period from 1990 to 2009 that reported data on the outcome of conservative or surgical treatment of spondylolysis in athletes.The articles were examined for data on the percentage of athletes who returned to sports activities and the interval between the start of treatment and their return.RESULTS:Five studies were identified.Two studies were concerned with conservative treatment and the other three with surgical treatment(wire fixation or screw fixation with bone graft).The percentages of athletes who returned to sports activities ranged from 80.0%to 89.3%and from 81.9%to 100%,respectively,and the intervals until their return ranged from 5.4 to 5.5 mo and from 7 to 12 mo,respectively.CONCLUSION:The percentages of athletes who returned to sports activities after conservative and surgical treatment appeared to be satisfactory,but the

Surgical strategy for high-grade isthmic spondylolisthesis of 5th lumbar vertebrae

Objective To investigate surgical strategy for high-grade isthmic spondylolisthesis(more thanⅡ degree)of 5th lumbar vertebrae.Methods From August 2003 to October 2008,26 patients with high-grade isthmic spondylolisthesis (L5) were

Study on clinical effects of pedicle screw combined with immobilized implantation bone by wirerope and hallow compression screw immobilization in treating spondylolysis of lumbar vertebra of multiple segments of adults

Objective:To observe clinical effects of pedicle screw fixation combined with cable wires and bone graft and cannulated compression screws on adult multi-segment lumbar spondylolysis.Methods:70 cases of patients with multi-segment lumbar spondylolysis were selected in our hospital.According to different surgical schemes,these patients were divided into the observation group(35 cases)and the control group(35 cases).The observation group received pedicle screw fixation combined with cable wires and bone graft and the control group received cannulated compression screw fixation.Macnab criteria were adopted to implement a therapeutic evaluation of two groups of patients to make an observation and comparison of the excellent and good rate of surgery and a series of indicators including perioperative clinical effects,intraoperative blood loss,duration of surgery,hospital length of stay(HLOS),visual analogue scale(VAS),Oswestry disability index and Japanese Orthopaedic Association(JOA)score.Results:The excellent and good rate of the observation group was 97.14%,and that of the control group was 82.86%,the difference between two groups was statistically significant(χ^(2)=6.248,p=0.012).The differences in intraoperative blood loss,duration of surgery and HLOS between two groups were statistically significant(t=-4.55,t=-4.55,t=-4.55;p<0.05).Oswestry index,VAS score and JOA score of the observation group were(2.4±0.9),(28.5±6.4)and(27.1±3.1)respectively,and these of the control group were(3.5±1.2),(37.1±7.8)and(21.3±2.7)respectively,the differences between two groups were statistically significant(t=4.338,t=5.043,t=8.347,p<0.05).Conclusions:Pedicle screw combined with immobilized implantation bone by wirerope has an excellent clinical effect on the treatment of adult multi-segment lumbar spondylolysis,and it has a series of advantages such as fast postoperative recovery,small surgical trauma and so on.In addition,this technique can also restore the stability of spinal segments and relieve pains to a greater degree.

Differences of Sagittal Lumbosacral Parameters between Patients with Lumbar Spondylolysis and Normal Adults

Background： Recent studies have suggested an association between elevated pelvic incidence （PI） and the development of lumbar spondylolysis. However, there is still lack of investigation for Hart Chinese people concerning the normal range ofspinopelvic parameters and relationship between abnormal sagittal parameters and lumbar diseases. The objective of the study was to investigate sagittal lumbosacral parameters of adult lumbar spondylolysis patients in Han Chinese population. Methods： A total of 52 adult patients with symptomatic lumbar spondylolysis treated in the General Hospital of Armed Police Force （Beijing, China） were identified as the spondylolysis group. All the 52 patients were divided into two subgroups, Subgroup A： 36 patients with simple lumbar spondylolysis, and Subgroup B： 16 patients with lumbar spondylolysis accompanying with mild lumbar spondylolisthesis （slip percentage 〈30%）. Altogether 207 healthy adults were chosen as the control group. All patients and the control group took lumbosacral lateral radiographs. Seven sagittal lumbosacral parameters, including PI, pelvic tilt （PT）, sacral slope （SS）, lumbar lordosis （LL）, L5 incidence, L5 slope, and sacral table angle （STA）, were measured in the lateral radiographs. All the parameters aforementioned were compared between the two subgroups and between the spondylolysis group and the control group with independent-sample t-test. Results： There were no statistically significant differences of all seven sagittal lumbosacral parameters between Subgroup A and Subgroup B. PI, PT, SS, and LL were higher （P 〈 0.05） in the spondylolysis group than those in the control group, but STA was lower （P 〈 0.001 ） in the spondylolysis group. Conclusions： Current study results suggest that increased PI and decreased STA may play important roles in the pathology of lumbar spondylolysis in Han Chinese population.

Incomplete spondylolysis of the first sacrum： a case report

Spondylolysis is generally attributed to stress fracture, due to movement of the affected vertebrae relative to the vertebra below and is most common in lower lumbar vertebrae.Since S1 and S2 are fused, spondylolysis of S1 due to stress fracture would unlikely to occur. Although there have been some reports of S1 spondylolysis in ancient Alaskan and Canadian lnuit skeletons, no clinical S1 spondylolysis case due to stress fracture has been reported until now. A 17-year-old, female gymnast with incomplete spondylolysis of S1 is presented here.

峡部裂腰椎滑脱患者椎旁肌对脊柱-骨盆矢状面的影响:肌肉数量和质量的评估

背景:横截面积和脂肪浸润为量化椎旁肌的标准参数,但是太过繁琐和费时,需要引入新的量化指标。目的:探讨峡部裂性腰椎滑脱患者椎旁肌和脊柱-骨盆矢状面参数测量值之间的关系,以及腰椎压痕值对矢状面平衡的预测价值。方法:选择诊断为峡部裂性腰椎滑脱的患者87例,均为Meyerding分型Ⅱ度滑脱,男40例,女47例,平均年龄(51.4±9.1)岁。测量患者脊柱-骨盆矢状面参数矢状面轴向距离、骨盆入射角、骨盆倾斜角、骶骨倾斜角、腰椎前凸角、胸椎后凸角、骨盆投射角与腰椎前凸角之差,以及腰椎旁肌的总横截面积、功能横截面积和脂肪浸润。使用Pearson相关分析法探讨矢状面参数与椎旁肌测量值的相关性;使用多元线性回归分析腰椎压痕值、年龄、性别和体质量指数对脊柱骨盆矢状面平衡的影响。通过受试者工作特征曲线寻找腰椎压痕值的最佳截断点,评价矢状面轴向距离和骨盆投射角与腰椎前凸角之差的关系。结果与结论:(1)根据Pearson相关分析结果,多裂肌总横截面积与腰椎前凸角(r=0.464,P <0.01)和骨盆投射角与腰椎前凸角之差(r=-0.306,P <0.01)显著相关;多裂肌功能横截面积与腰椎前凸角(r=0.367,P <0.01)和骨盆投射角与腰椎前凸角之差(r=-0.228,P <0.05)存在显著相关性;腰椎压痕值与矢状面轴向距离(r=-0.300,P <0.01)、腰椎前凸角(r=0.417,P <0.01)、胸椎后凸角(r=0.351,P <0.01)和骨盆投射角与腰椎前凸角之差(r=-0.319,P <0.01)有显著相关性;(2)根据多元线性回归分析结果,腰椎压痕值和骨盆投射角与腰椎前凸角之差以及矢状面轴向距离独立相关;腰椎压痕值≤11.5 mm的患者矢状面轴向距离≤50 mm发生率为55%(11/20),而腰椎压痕值> 11.5 mm的患者矢状面轴向距离≤50 mm发生率为96%(64/67);骨盆投射角与腰椎前凸角之差≤11.5 mm的患者骨盆投射角与腰椎前凸角之差≤10°的发生率为30%(6/20),而腰椎压痕值> 11.5 mm的患者骨盆投射角与腰椎前凸角之差≤10°的发生率为66%(44/67);(3)提示多裂肌总横截面积和功能横截面积均与腰椎前凸角和骨盆投射角与腰椎前凸角之差显著相关;腰椎压痕值作为评价椎旁肌退变的新指标,与矢状面轴向距离和骨盆投射角与腰椎前凸角之差独立相关,对术后矢状面矫正有一定的预测价值,是一种简单实用的评估脊柱-骨盆矢状面和椎旁肌退变的方法;椎旁肌的退变与脊柱-骨盆矢状面平衡有关。

退行性和峡部裂性腰椎滑脱患者椎旁肌肉组织退变的影像学比较

背景:现有研究已对退行性腰椎滑脱患者与健康人群椎旁肌肉退变程度的差异进行了比较,但还缺乏不同腰椎滑脱症种类之间影像参数差异的比较研究。目的:探讨峡部裂性腰椎滑脱与退行性腰椎滑脱患者在椎旁肌肉组织退变方面的差异,以及与腰背痛症状的相关性。方法:对2019年2月至2023年8月在徐州医科大学附属医院治疗的107例腰椎滑脱患者进行回顾性分析,根据滑脱类型将患者分为2组,峡部裂性腰椎滑脱组39例,退行性腰椎滑脱组68例。对比分析两组患者椎旁肌组织影像学参数情况以及腰背痛目测类比评分,依据目测类比评分,将两组患者分别分为目测类比评分≤45 mm和>45 mm两个亚组,分析目测类比评分差异与椎旁肌肉组织退变参数的关系。结果与结论:①退行性腰椎滑脱组患者多裂肌的脂肪浸润百分比高于峡部裂性腰椎滑脱组(P=0.003);②两组腰背痛目测类比评分≤45 mm的患者多裂肌脂肪浸润百分比低于腰背痛目测类比评分>45 mm患者(P=0.021,P<0.001);③峡部裂性腰椎滑脱组还表现出腰背痛目测类比评分≤45 mm的患者竖脊肌脂肪浸润百分比低于腰背痛目测类比评分>45 mm患者(P=0.002);④结果显示,峡部裂性腰椎滑脱患者和退行性腰椎滑脱患者在椎旁肌肉组织退化方面存在显著差异,且退行性腰椎滑脱患者相比峡部裂性腰椎滑脱患者展现出更为严重的椎旁肌退化;此外,两组腰椎滑脱患者中,疼痛较严重者的多裂肌脂肪浸润程度相对较高。

Rare bilateral C3 cervical spondylolysis: Report of four cases and a literature review

Objective: To review and discuss the etiology, diagnosis and treatment C3 of bilateral cervical spondylolysis. Methods: This was a retrospective review of the clinical features, imaginge findings,and treatment of 4 cases of bilateral C3 cervical spondylolysis, with a review of the literature. Results: A 21‐year‐old woman, a 26‐year‐old man, a 14‐year‐old boy, and a 46‐year‐old man were diagnosed with bilateral C3 cervical spondylolysis. The patients had characteristic bilateral clefts between the articular pillar and the facets of C3, as well as spina bifida on CT. Although spondylolisthesis was not observed, spinal cord compression was definitive. All patients underwent posterior decompression with satisfactory results. Conclusions: C3 cervical spondylolysis is rare condition. The cause is most likely congenital. Diagnosis is dependent on characteristic radiological features. Surgical treatment is the first choice.

Cervico-Isthmic Pregnancy on Cesarean Scar Successful Treated with Methotrexate, Mifepristone and Misoprostol: A Case Report

Introduction: Cervico-isthmic pregnancy is rare, and serious because of its hemorrhagic complication. Its management varies according to the teams. Observation: We report a case of cervico-isthmic pregnancy on a cesarean scar. This is a 35-year-old, G2P2, who consulted for bleeding from the 1st trimester of pregnancy. The clinical examination found a minimal uterine bleeding. The diagnosis was made by a vaginal ultrasound which found a cervico-isthmic implantation of the pregnancy on the caesarean scar. A protocol of Mifepristone and Misoprostol followed by administration of a single dose of 1 mg/kg of Methotrexate was performed. Cure was obtained 1 month after treatment by negativation of plasma HCG. No bleeding complications were noted. A follow-up ultrasound performed 2 months later showed a uterine vacuity and the presence of an isthmocoele. It was in fact a pregnancy that had implanted in the isthmocoele. Conclusion: Cervico-isthmic pregnancy is rare. His treatment is not codified. Drug management was successful.

Isthmic spondylolisthesis: Interpretation of NASS guidelines for evidence-based medicine

Isthmic spondylolisthesis in adults is a common clinical disease that causes lower back pain. In order to provide the best and effective diagnosis and treatment plan, in 2014, the North American Spine Association (NASS) formulated the guidelines for the diagnosis and treatment of isthmic spondylolisthesis in adult (hereinafter referred to as the guideline). Through the systematic review of literature, evidence-based medical evidence analysis was conducted to identify different recommended intensities, to discuss the clinical diagnosis and treatment plan mainly from two aspects of diagnosis and treatment. This article gives a brief explanation of the guidelines and discusses them in combination with the clinical practice in China, so as to provide a reference for clinicians.

术前体位复位联合术中提拉复位辅助Mis-TLIF技术治疗峡部裂型腰椎滑脱

目的:探讨应用微创经椎间孔腰椎椎间融合术(minimally invasive transforaminal lumbar interbody fusion,Mis-TLIF)结合术前体位复位治疗峡部裂型腰椎滑脱的临床效果并总结其优点。方法:回顾性分析2016年7月至2022年7月收治的60例腰椎峡部裂型滑脱患者,其中男26例,女34例;年龄35~72(51.32±4.24)岁。依据手术方式分为观察组和对照组。观察组30例,男12例,女18例;年龄35~71(51.80±6.38)岁;病程12~60(24.17±1.98)个月;L4滑脱18例,L5滑脱12例;Meyerding分级Ⅰ度滑脱20例,Ⅱ度滑脱10例;采用术前体位复位联合术中撑开复位后经Quadrant通道Mis-TLIF。对照组30例,男14例,女16例;年龄36~72(50.00±4.24)岁;病程12~60(23.70±1.53)个月;L4滑脱16例,L5滑脱14例;Meyerding分级Ⅰ度滑脱19例,Ⅱ度滑脱11例;采用传统后路开放椎体融合术治疗。分析两组的手术时间、术中及术后出血量、术后住院时间、放射线暴露时间和并发症等方面的差异。采用视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)及日本骨科协会(Japanese Orthopaedic Association,JOA)评分(腰椎评分标准)评估临床效果,随访复查X线及CT评估椎间融合情况。结果:所有患者获得12个月的随访。两组在手术时间、腰痛VAS、滑脱角、滑脱率等方面差异无统计学意义(P>0.05)。观察组术中术后出血量(165.50±15.56)、(59.17±10.59)ml,均少于对照组(259.33±35.32)、(165.33±29.56)ml(P<0.05);观察组住院时间(3.53±0.68)d,少于对照组(5.20±0.41)d(P<0.05);末次随访时两组椎间隙高度、滑脱角、滑脱率、ODI、VAS、JOA评分均较术前明显改善(P<0.05)。末次随访观察组与对照组ODI[(9.93±1.11)%vs(10.93±1.11)%]和JOA[(26.07±1.01)分vs(25.43±1.25)分]比较,差异有统计学意义(P<0.05)。结论:在峡部裂型腰椎滑脱的治疗中,术前体位复位联合术中提拉复位辅助Mis-Tlif技术相比传统开放性手术具有创伤小、出血少、住院周期短等优点,是一种安全有效的技术。

椎旁肌退变与L5/S1峡部裂性腰椎滑脱程度的关系

目的:探究椎旁肌退变与L5/S1峡部裂性腰椎滑脱程度的关系。方法:回顾性分析2020年1月1日~2023年12月31日郑州大学第一附属医院骨科收治的108例L5/S1双侧峡部裂患者的临床资料,其中女62例,男46例,年龄26~86(52.8±10.4)岁,所有患者腰椎侧位及动力位X线、腰椎CT和腰椎MRI等影像学资料完整。根据是否伴有滑脱及Meyerding分度将患者分为无滑脱组(28例)、Ⅰ度滑脱组(46例)和Ⅱ度滑脱组(34例)。在腰椎轴位MRI的L5下终板层面测量椎体横截面积(V CSA)、竖脊肌横截面积(ES CSA)、多裂肌横截面积(MF CSA)以及关节突关节角度(FJA),并计算平均关节突关节角度(mFJA)、多裂肌相对横截面积(MF rCSA)、竖脊肌相对横截面积(ES rCSA)、多裂肌脂肪浸润率(MF FIR)及竖脊肌脂肪浸润率(ES FIR)。比较三组间年龄、性别、体质指数(BMI)、病程、V CSA、mFJA、MF CSA、ES CSA、MF rCSA、ES rCSA、MF FIR以及ES FIR之间的差异,并使用有序Logistics回归分析年龄、性别、病程、BMI、mFJA、MF rCSA、ES rCSA、MF FIR、ES FIR等参数与峡部裂性腰椎滑脱程度的关系。结果:各组间年龄、体重、BMI、V CSA、mFJA无统计学差异(P>0.05)。无滑脱组女性患者(29%)占比显著低于Ⅰ度滑脱组(61%)和Ⅱ度滑脱组(76%)(P<0.05);无滑脱组的身高(1.68±0.06m)相较于Ⅰ度滑脱组(1.64±0.75m)和Ⅱ度滑脱组(1.63±0.54m)更高(P<0.05),病程相较于Ⅰ度滑脱组和Ⅱ度滑脱组更短(P<0.05)。三组间MF CSA、MF rCSA以及ES FIR差异均无统计学意义(P>0.05),Ⅱ度滑脱组的ES CSA和ES rCSA(3183.2±1196.38mm^(2)和2.14±1.11)显著高于Ⅰ度滑脱组(2579.28±896.56mm^(2)和1.65±0.65)及无滑脱组(2401.40±742.98mm^(2)和1.56±0.58)(P<0.05);Ⅱ度滑脱组的MF FIR(40.70±14.05)%显著高于Ⅰ度滑脱组(30.39±12.98)%及无滑脱组(26.69±9.96)%(P<0.05);Ⅰ度滑脱组与无滑脱组间ES CSA、ES rCSA和MF FIR差异无统计学意义(P>0.05);有序Logistics回归分析结果显示,女性(OR=2.81,95%CI:1.120~7.062,P=0.028)及MF FIR增加(OR=1.044,95%CI:1.003~1.088,P=0.034)是峡部裂性腰椎滑脱程度加重的独立危险因素(P<0.05)。结论:滑脱程度较重的双侧峡部裂患者多裂肌脂肪浸润更严重,并且出现了竖脊肌的肥大,女性及MF FIR增加是峡部裂性腰椎滑脱程度加重的独立危险因素。

青年腰椎峡部裂手术直接修复治疗与非手术治疗的比较

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。

全内窥镜下后方经椎板间入路腰椎椎间融合术治疗单节段腰椎退行性疾病

目的评估全内窥镜下后方经椎板间入路腰椎椎间融合术(FE-PLIF)治疗单节段腰椎退行性疾病的临床疗效。方法2019年3月—2021年3月采用FE-PLIF治疗单节段腰椎退行性疾病患者27例,记录术前和术后3 d、3个月、6个月、1年的腰腿痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)。记录手术相关并发症发生情况,术后1年评估椎间融合率。结果所有手术顺利完成。所有患者术后各时间点腰腿痛VAS评分和ODI较术前显著改善,术后3个月、6个月和1年时较术后3 d显著改善,差异均有统计学意义(P<0.05)。发生术后血肿1例,其余患者均未发生神经或血管损伤并发症。术后1年25例患者椎间骨性融合,融合率为92.6%(25/27)。结论FE-PLIF治疗单节段腰椎退行性疾病安全有效,术后融合率高。

腰臀比对腰椎退行性疾病术后疗效的影响

目的:探讨腰臀比对腰椎退行性疾病术后疗效的影响。方法:回顾性分析1220例腰椎退行性疾病患者的病例资料,其中低腰臀比组102例(男性腰臀比<0.85,女性腰臀比<0.75)、正常腰臀比组705例(男性腰臀比为0.85~0.9,女性腰臀比为0.75~0.8)、高腰臀比组413例(男性腰臀比>0.9,女性腰臀比>0.8)。比较3组患者的手术时间、术中出血量、术后1年Oswestry功能障碍指数(Oswestry disability index,ODI)及腰背部、臀部、腿部、足部疼痛数字评分。结果:(1)一般结果。3组患者的手术时间、术中出血量比较,组间差异均有统计学意义[(118.8±25.6)min,(125.5±18.8)min,(139.3±26.6)min,F=11.238,P=0.001;(125.4±20.6)mL,(140.9±28.6)mL,(188.2±31.6)mL,F=14.262,P=0.035]。高腰臀比组患者手术时间长于正常腰臀比组和低腰臀比组(P=0.001,P=0.001),术中出血量多于正常腰臀比组和低腰臀比组(P=0.001,P=0.001);正常腰臀比组患者的手术时间、术中出血量和低腰臀比组比较,组间差异均无统计学意义(P=0.136,P=0.117)。(2)术后1年疼痛数字评分。3组患者术后1年腰背部、臀部、腿部疼痛数字评分比较,组间差异均有统计学意义[(2.60±0.96)分,(2.17±0.84)分,(3.27±1.10)分,F=17.901,P=0.036;(1.45±0.52)分,(1.49±0.50)分,(2.78±0.85)分,F=54.421,P=0.001;(2.09±0.70)分,(2.13±0.98)分,(2.80±1.16)分,F=6.239,P=0.003];足部疼痛数字评分比较,差异无统计学意义[(1.55±0.52)分,(1.39±0.49)分,(1.29±0.46)分,F=1.731,P=0.182]。高腰臀比组患者术后1年腰背部、臀部、腿部疼痛数字评分均高于低腰臀比组和正常腰臀比组(P=0.045,P=0.001;P=0.047,P=0.003;P=0.029,P=0.001),正常腰臀比组患者术后1年腰背部、臀部、腿部疼痛数字评分和低腰臀比组比较,组间差异均无统计学意义(P=0.176,P=0.291,P=0.716)。(3)术后1年ODI。3组患者术后1年ODI比较,差异有统计学意义[(19.40±6.52)%,(12.59±6.81)%,(24.28±9.83)%,F=30.502,P=0.001]。高腰臀比组患者术后1年ODI高于正常腰臀比组和低腰臀比组(P=0.001,P=0.042),低腰臀比组患者术后1年ODI高于正常腰臀比组(P=0.019)。结论:高腰臀比会增加腰椎退行性疾病患者的手术时间和术中出血量,影响患者术后疼痛缓解和腰椎功能恢复。