Okuwaki Shun, Tatsumura Masaki, Gamada Hisanori, Asai Reo, Nagashima Katsuya, Takeuchi Yosuke, Funayama Toru, Yamazaki Masashi
Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
Department of Orthopedic Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Mito, Japan.
Spine Surg Relat Res. 2023 Sep 4;8(1):58-65. doi: 10.22603/ssrr.2023-0084. eCollection 2024 Jan 27.
The smiley face rod method is an effective treatment for symptomatic terminal-stage spondylolysis. However, the risk factors for treatment failure are unknown. We investigated the association of pars defect type with the treatment outcomes of this method.
We retrospectively examined data from 34 patients (18.0±6.7 years) with terminal-stage spondylolysis who underwent surgery using the smiley face rod method. The mean follow-up period was 44.9±21.4 months. The patients were divided into 2 groups: pars defect without bone atrophy or sclerosis (group A; 18 patients), and with bone atrophy and sclerosis (group B; 16 patients). We evaluated and compared the visual analog scale (VAS) score for back pain, bone union rate, and time to return to preinjury athletics level between the groups. Fisher exact and paired tests were used to compare the variables between groups. The VAS score between the groups was compared using a 2-factor repeated-measures analysis of variance.
Within groups, the VAS score was significantly different over time (<0.001). The VAS scores between groups were not significantly different. Patients in group A had a significantly higher bone union rate per pars at 6 months (group A, 65.7%; and group B, 37.5%, =0.028) and 24 months after surgery (group A, 97.1%; and group B, 75.0%, =0.011). All patients returned to their respective sports, and no significant differences were observed in the time to return to preinjury athletics level between the groups (=0.055).
The type of pars defect are associated with bone union after the smiley face rod method, but have little effect on postoperative symptoms.
笑脸棒法是治疗有症状的终末期峡部裂的一种有效方法。然而，治疗失败的危险因素尚不清楚。我们研究了峡部缺损类型与该方法治疗效果之间的关联。
我们回顾性分析了34例（平均年龄18.0±6.7岁）接受笑脸棒法手术的终末期峡部裂患者的数据。平均随访时间为44.9±21.4个月。患者分为两组：无骨质萎缩或硬化的峡部缺损患者（A组，18例）和有骨质萎缩及硬化的患者（B组，16例）。我们评估并比较了两组之间的背痛视觉模拟评分（VAS）、骨愈合率以及恢复到伤前运动水平的时间。采用Fisher精确检验和配对检验比较组间变量。组间VAS评分采用双因素重复测量方差分析进行比较。
在组内，VAS评分随时间有显著差异（<0.001）。组间VAS评分无显著差异。A组患者在术后6个月（A组为65.7%，B组为37.5%，P=0.028）和24个月时（A组为97.1%，B组为75.0%，P=0.011）每处峡部的骨愈合率显著更高。所有患者均恢复了各自的运动，两组之间恢复到伤前运动水平的时间无显著差异（P=0.055）。
峡部缺损类型与笑脸棒法术后的骨愈合有关，但对术后症状影响较小。
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