Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY.
Norton Leatherman Spine Center, Louisville, KY.
Spine (Phila Pa 1976). 2024 Sep 1;49(17):1235-1240. doi: 10.1097/BRS.0000000000004886. Epub 2023 Nov 28.
A retrospective chart review.
The objective of this study is to investigate whether direct pars repair achieves bone healing and symptom relief in patients with spondylolitic spondylolisthesis.
While most cases of spondylolysis can be managed nonoperatively, a small percentage of patients require surgical intervention. The outcome of direct pars repair through a standard pedicle-screw with wiring technique is controversial in patients with lumbar spondylolitic spondylolisthesis.
Medical records of patients who had undergone an open surgical pars repair were retrospectively reviewed. Standard demographic and surgical parameters were collected. All patients underwent a primary repair of the pars with an autograft or bone morphogenetic protein and instrumentation using a pedicle-screw with spinous process wiring. At 6 to 12 months after the surgery, patient's pain symptoms, and postoperative computed tomography (CT) scans were independently reviewed to assess healing; which was graded as nonunion, partial union, or solid union.
There were 68 patients identified (33 male and 35 female), with an average age of 18.6 years. The mean estimated blood loss was 139 ml, and the mean length of hospital stay was 3.7 days. CT evaluation revealed 35 (52%) solid unions, 21 (31%) partial unions, and 12 (18%) nonunions requiring revisions. Thirty-four (50%) patients had no postoperative pain, 24 (35%) had mild pain, and 10 (15%) had persistent pain. The majority of patients with nonunions on CT had mild or persistent pain. Patients with no or mild pain tended to be younger than those with persistent pain (17.5 vs. 24.6 yr, P =0.163).
This study demonstrated a partial or complete union rate of 82% and a postoperative persistent pain rate of 15%. These figures are comparable to the previous study, and this pedicle-screw with wiring technique can be worth trying before interbody fusion for spondylolytic spondylolisthesis to preserve anatomical lumbar motion.
回顾性图表分析。
本研究旨在探讨直接峡部修复术是否能使峡部裂性脊椎滑脱患者的骨骼愈合并缓解症状。
大多数峡部裂可以非手术治疗，但一小部分患者需要手术干预。在腰椎峡部裂性脊椎滑脱患者中，通过标准椎弓根螺钉加钢丝技术进行直接峡部修复的效果存在争议。
回顾性分析接受开放峡部修复手术的患者的病历。收集了标准的人口统计学和手术参数。所有患者均采用自体移植物或骨形态发生蛋白进行峡部初次修复，使用椎弓根螺钉加棘突钢丝进行器械固定。术后 6 至 12 个月，对患者的疼痛症状和术后 CT 扫描进行独立评估，以评估愈合情况；愈合情况分为未愈合、部分愈合和完全愈合。
共确定了 68 例患者（33 名男性和 35 名女性），平均年龄为 18.6 岁。平均估计失血量为 139ml，平均住院时间为 3.7 天。CT 评估显示 35 例（52%）为完全愈合，21 例（31%）为部分愈合，12 例（18%）为未愈合需行翻修。34 例（50%）患者术后无疼痛，24 例（35%）患者轻度疼痛，10 例（15%）患者持续疼痛。大多数 CT 检查显示未愈合的患者有轻度或持续的疼痛。CT 检查显示未愈合的患者中有疼痛的比例高于完全愈合的患者（50% vs. 15%，P=0.027）。无或轻度疼痛的患者比持续疼痛的患者更年轻（17.5 岁 vs. 24.6 岁，P=0.163）。
本研究显示部分或完全愈合率为 82%，术后持续性疼痛率为 15%。这些数据与之前的研究相似，在进行椎间融合之前，这种椎弓根螺钉加钢丝技术对于峡部裂性脊椎滑脱可以尝试保留腰椎的解剖运动。
