经皮椎弓根螺钉和椎板钩直接修复峡部裂性腰椎滑脱术后不融合的相关因素：临床和 CT 评估研究。
Factors associated with non-fusion after direct pars repair of lumbar spondylolysis with pedicle screw and lamina hook: a clinical and CT-assessed study.
机构信息
Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
出版信息
BMC Musculoskelet Disord. 2024 Feb 17;25(1):152. doi: 10.1186/s12891-024-07252-0.
BACKGROUND
Pedicle screw and lamina hook (PSLH) technique is an effective and popular method for direct pars repair of lumbar spondylolysis. There is a lack of studies to explore factors that may influence the healing of spondylolysis after direct pars repair surgery. The present study aimed to investigate the factors associated with non-fusion after direct pars repair of lumbar spondylolysis with PSLH technique.
METHODS
A total of 55 subjects (average age 21.1 ± 6.3 years, a total of 120 pars defects) diagnosed with symptomatic spondylolysis and underwent pars repair surgery with PSLH were followed up and their clinical data were analyzed. Subjects were divided into a non-fusion group and fusion group according to whether the pars defect had bony fusion at last follow-up assessed by CT. Radiographic data, data related to spondylolysis and clinical outcomes were collected and compared between groups.
RESULTS
The mean follow-up time of the 55 patients was 24.8 ± 12.0 (12-64) months. Among the 120 pars defects, 101 defects were successfully fused and 19 were not fused according to CT. The fusion rate was 84.2%. Multivariable logistic regression analysis showed the factors correlated with non-fusion after pars repair surgery: whether the spondylolysis segment was associated with spina bifida occulta (SBO) (P = 0.001), stage of the defect (P = 0.047), width of the defect (P = 0.002), and disc degeneration (P = 0.014).
CONCLUSION
Direct pars repair by PSHL is a reliable treatment for lumbar spondylolysis with a fusion rate of 84.2%. Association with SBO of the spondylolysis segment, a terminal stage of the defect, a wider defect gap, and grade III disc degeneration may be factors associated with non-fusion after direct pars repair of lumbar spondylolysis with PLSH. Non-fusion patients after pars repair appear to have worse clinical results compared to fusion patients.
背景
经皮椎弓根螺钉和椎板钩（PSLH）技术是治疗腰椎峡部裂的有效且流行的方法。目前缺乏研究来探讨可能影响经皮峡部裂直接修复术后峡部裂愈合的因素。本研究旨在探讨经皮椎弓根螺钉和椎板钩（PSLH）技术治疗腰椎峡部裂术后非融合的相关因素。
方法
共随访 55 例（平均年龄 21.1±6.3 岁，共 120 个峡部裂）症状性峡部裂患者，采用 PSLH 行峡部裂修复术，并对其临床资料进行分析。根据 CT 检查最后随访时峡部裂是否有骨融合，将患者分为融合组和未融合组。收集并比较两组的影像学资料、峡部裂相关资料和临床结果。
结果
55 例患者的平均随访时间为 24.8±12.0（12-64）个月。120 个峡部裂中，101 个成功融合，19 个未融合。融合率为 84.2%。多变量逻辑回归分析显示，经皮椎弓根螺钉和椎板钩修复术后峡部裂未融合的相关因素：峡部裂节段是否合并隐性脊柱裂（SBO）（P=0.001）、缺损分期（P=0.047）、缺损宽度（P=0.002）、椎间盘退变（P=0.014）。
结论
经皮椎弓根螺钉和椎板钩（PSHL）直接修复术是治疗腰椎峡部裂的一种可靠方法，融合率为 84.2%。峡部裂节段合并 SBO、缺损终末期、更宽的缺损间隙和 III 级椎间盘退变可能是经皮椎弓根螺钉和椎板钩（PSHL）治疗腰椎峡部裂后不融合的相关因素。与融合患者相比，峡部裂修复术后不融合的患者临床结果似乎更差。
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