Dai L Y, Jia L S, Yuan W, Ni B, Zhu H B
Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Second Medical University, 1665 Kongjiang Road, Shanghai 200092, China.
Eur Spine J. 2001 Feb;10(1):78-83. doi: 10.1007/s005860000205.
Forty-six patients with lumbar spondylolysis and mild isthmic spondylolisthesis were managed with direct repair of the defect with or without facet joint fusion in the affected segment. There were 24 males and 22 females, ranging in age from 15 to 56 years (average, 38.2 years). These patients had experienced clinical symptoms due to spondylolysis for between 4 months and 20 years (average, 5.3 years). Of 46 patients, 28 had no spondylolisthesis, 11 had Meyerding grade I vertebral slippage and 7 had grade II. Direct repair of 98 defects was performed on these patients. Twenty-six patients, in whom the disc adjacent to the defect was determined as degenerative by magnetic resonance imaging (MRI), simultaneously underwent facet joint fusion; 17 in one segment and 9 in two segments. The average period of follow-up was 50 months (24-92 months). Ninety-four defects achieved bony healing. As a result, 28 patients were graded as having an excellent outcome, 15 good, and 3 fair. Bone grafting in the defects achieves union between the loose lamina and the anterior element of lumbar vertebrae, and reconstructs the anatomic structure and physiologic functions of the lumbar vertebrae. There was no significant difference in outcome between the spondylolytic/spondylolisthetic patients with non-degenerative disc, who were treated with direct repair of defect only, and those with degenerative disc, who additionally underwent a fusion procedure (P > 0.05). The present series demonstrates a satisfactory result and a high rate of bony healing of the pars defect by this operative procedure in patients with lumbar spondylolysis and mild isthmic spondylolisthesis. Preoperative assessment of the disc degeneration with MRI is of great assistance in making the protocol choice of whether to opt for fusion.
46例腰椎峡部裂合并轻度峡部裂性脊椎滑脱患者接受了病变节段缺损的直接修复，部分患者同时进行了小关节融合。其中男性24例，女性22例，年龄15至56岁（平均38.2岁）。这些患者因腰椎峡部裂出现临床症状的时间为4个月至20年（平均5.3年）。46例患者中，28例无脊椎滑脱，11例为Meyerding I级椎体滑脱，7例为II级。对这些患者的98处缺损进行了直接修复。26例经磁共振成像（MRI）检查确定缺损相邻椎间盘退变的患者同时进行了小关节融合，其中17例为单节段融合，9例为双节段融合。平均随访时间为50个月（24 - 92个月）。94处缺损实现了骨愈合。结果，28例患者疗效评定为优，15例为良，3例为可。缺损处植骨实现了松动椎板与腰椎前部结构的连接，重建了腰椎的解剖结构和生理功能。仅接受缺损直接修复的非退变椎间盘的峡部裂/峡部裂性脊椎滑脱患者与同时接受融合手术的退变椎间盘患者的疗效差异无统计学意义（P > 0.05）。本系列研究表明，该手术方法治疗腰椎峡部裂合并轻度峡部裂性脊椎滑脱患者可获得满意疗效和较高的骨愈合率。术前通过MRI评估椎间盘退变情况对选择是否进行融合手术方案有很大帮助。
