青少年重度腰椎滑脱复位技术的长期经验
Long-Term Experience With Reduction Technique in High-Grade Spondylolisthesis in the Young.
作者信息
Sudarshan Pramod K, Suthar Hardik R, Varma Vamsi K, Krishnan Appaji, Hegde Sajan K
机构信息
Apollo Hospitals, Chennai, India.
SIMS Hospitals, Chennai, India.
出版信息
Int J Spine Surg. 2018 Aug 15;12(3):399-407. doi: 10.14444/5047. eCollection 2018 Jun.
BACKGROUND
Surgical management of high-grade spondylolisthesis in the young is not only challenging but also controversial, from in-situ fusion to complete reduction. It is fraught with dangers such as neurological injury, pseudoarthrosis, and progressive deformity with subsequent global sagittal imbalance. We describe our experience of progressive reduction technique and restoration of lumbosacral alignment.
METHODS
This study is a retrospective review of patients who underwent surgery between 1998 and 2012. The surgical technique involved positioning the hips in extension with traction, pedicle screw fixation, correction of lumbosacral kyphosis with a specific distraction maneuver, wide decompression, and gradual reduction of the deformity and maintenance of reduction with interbody fusion. All patients were serially assessed at 1, 3, and 6 months and yearly thereafter with clinical, radiological, and Oswestry Disability Index and Visual Analogue Scale outcome measures.
RESULTS
Twenty-seven patients with high-grade spondylolisthesis at L5-S1 (3 cases grade 3, 7 grade 4, 17 grade 5) with an average age of 13.9 years were reviewed. Mean follow-up was 120 months (range 24-192). All patients presented a solid fusion at the 6-month visit; mean slip percentage was reduced from 89% to 23%, with all cases reduced to grade 2 or less. The slip angle improved from 45° to 3° postoperatively, with improvement in sacral slope from 13° to 35°. Four spondyloptosis patients had concomitant scoliosis which corrected spontaneously after the surgery and did not need further intervention. All but one patient (96.2%) had good functional outcomes and returned to their full normal activities. One patient developed a deep infection necessitating implant removal, with eventual deformity progression leading to a poor outcome. Three patients (11.1%) suffered partial drop foot that resolved in full by 12 weeks.
CONCLUSION
Our technique demonstrated a significant reduction of high grade spondylolisthesis, with restoration of global sagittal balance via correction of the lumbosacral kyphosis. Though surgically demanding, it is safe and reproducible.
LEVEL OF EVIDENCE
IV.
背景
对于年轻患者的重度腰椎滑脱症，从原位融合到完全复位，手术治疗不仅具有挑战性，而且存在争议。该手术充满风险，如神经损伤、假关节形成以及随后出现整体矢状面失衡的渐进性畸形。我们描述了我们在渐进性复位技术及恢复腰骶部对线方面的经验。
方法
本研究是对1998年至2012年间接受手术患者的回顾性分析。手术技术包括通过牵引使髋关节伸展位固定、椎弓根螺钉固定、采用特定撑开操作矫正腰骶部后凸、广泛减压、逐步矫正畸形并通过椎间融合维持复位。所有患者在术后1、3和6个月以及之后每年均接受临床、影像学评估，以及采用奥斯维斯特里功能障碍指数和视觉模拟评分进行疗效评估。
结果
回顾了27例L5 - S1节段重度腰椎滑脱症患者（3例为3度，7例为4度，17例为5度），平均年龄13.9岁。平均随访120个月（范围24 - 192个月）。所有患者在术后6个月时均实现了牢固融合；平均滑脱百分比从89%降至23%，所有病例均降至2度或更低。滑脱角术后从45°改善至3°，骶骨倾斜度从13°改善至35°。4例腰椎椎体滑脱患者合并脊柱侧弯，术后自发矫正，无需进一步干预。除1例患者（96.2%）外，所有患者功能结局良好，恢复了正常全部活动。1例患者发生深部感染，需要取出内固定物，最终畸形进展导致预后不良。3例患者（11.1%）出现部分足下垂，在12周时完全恢复。
结论
我们的技术显著降低了重度腰椎滑脱症的程度，通过矫正腰骶部后凸恢复了整体矢状面平衡。尽管手术要求较高，但该技术安全且可重复。
证据级别
IV级
Zotero 插件