Yan Peng, Liu Jin-Hui, Cui Jing-Fu, Zheng Wei-Dong, Mu Xin-Ling, Gao Xu, Ma Yu-Fei, Du Juan
Department of Spinal Surgery, the First People's Hospital of Zhengzhou, Zhengzhou 450000, Henan, China;
Department of Spinal Surgery, the First People's Hospital of Zhengzhou, Zhengzhou 450000, Henan, China.
Zhongguo Gu Shang. 2019 Dec 25;32(12):1156-1159. doi: 10.3969/j.issn.1003-0034.2019.12.018.
To investigate the long-term effect of posterior lumbar pedicle screw fixation combined with isthmus bone grafting and fusion in young patients with spondylolysis.
A retrospective study was carried out, consisting of 16 young patients with lumbar spondylolysis without spondylolisthesis treated by lumbar posterior pedicle screw fixation combined with isthmic bone grafting fusion from January 2006 to July 2014. There were 11 males and 5 females, aged from 18 to 21 years old, with an average age of 19.3 years old, and the course of disease ranged from 12 to 26 months, with an average of 22 months. All the patients suffered from lumbar pain and difficulty in getting out of bed. Preoperative CT confirmed 12 cases of L₅ isthmus fissure and 4 cases of L₄ isthmus fissure. Bone graft fusion was confirmed and internal fixation was removed after operation. Lumbar spondylolysis was evaluated by lumbago visual analogue scoring method at preoperative and postoperative time points. Lumbar isthmic fusion was evaluated by lumbar CT, and degeneration of fixed and adjacent segments of lumbar intervertebral disc was evaluated by lumbar MRI.
Of the 16 patients, 13 patients (26 sides) were followed up, with a mean duration of 96 months. The operation time ranged from 80 to 105 minutes, with an average of 95 minutes. The intraoperative bleeding volume ranged from 150 to 300 ml, with an average of 225 ml. All the patients were successfully operated without any complications related to the operation. VAS scores at each time point after operation were improved compared with those before operation(<0.01). Postoperative CT scans of lumbar spine showed osseous fusion at 6 to 14 months, with an average of 12 months. There were no changes of adjacent segment degeneration, fixed segment disc degeneration and protrusion on lumbar spine MRI, and no symptomatic recurrence or recurrent spondylolysis in the long term.
The posterior lumbar pedicle screw fixation combined with isthmic bone grafting and fusion is safe and effective in the treatment of young spondylolysis. The fusion rate is high and the interference of normal physiological range is reduced. The long-term effect is satisfactory.
探讨后路腰椎椎弓根螺钉固定联合峡部植骨融合术治疗年轻腰椎峡部裂患者的远期疗效。
进行一项回顾性研究，纳入2006年1月至2014年7月期间采用腰椎后路椎弓根螺钉固定联合峡部植骨融合术治疗的16例无腰椎滑脱的年轻腰椎峡部裂患者。其中男性11例，女性5例，年龄18～21岁，平均19.3岁，病程12～26个月，平均22个月。所有患者均有腰痛及起床困难。术前CT证实L₅峡部裂12例，L₄峡部裂4例。术后证实骨融合并取出内固定。分别于术前、术后采用腰痛视觉模拟评分法评估腰椎峡部裂情况。采用腰椎CT评估腰椎峡部融合情况，采用腰椎MRI评估固定节段及相邻节段腰椎间盘退变情况。
16例患者中13例（26侧）获得随访，平均随访时间96个月。手术时间80～105分钟，平均95分钟。术中出血量150～300 ml，平均225 ml。所有患者手术均成功，未发生与手术相关的并发症。术后各时间点VAS评分均较术前改善（<0.01）。术后腰椎CT扫描显示6～14个月出现骨性融合，平均12个月。腰椎MRI显示相邻节段退变、固定节段椎间盘退变及突出无变化，长期无症状复发或复发性峡部裂。
后路腰椎椎弓根螺钉固定联合峡部植骨融合术治疗年轻腰椎峡部裂安全有效，融合率高，对正常生理范围干扰小，远期疗效满意。
