峡部植骨修复运动节段固定治疗青少年腰椎峡部裂研究
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摘要
背景:峡部裂是青少年腰痛的常见原因,也是造成后期腰椎滑脱的危险因素。目的目的:研究峡部清理取髂骨植骨运动节段固定治疗青年腰椎峡部裂的手术效果。方法方法:回顾分析2013年10月至2015年10月采用峡部清理取髂骨植骨运动节段固定治疗青年腰椎峡部裂的患者128例,均为单节段双侧峡部裂患者。分析患者的年龄,峡部裂节段分布,疼痛程度,下肢根性症状。术前根据CT横扫将峡部裂分为I型线型,II型中间型;III型硬化型。术后使用CT矢状位重建判断愈合情况,连续性的骨痂形成为峡部愈合的标准,记录愈合时间。愈合取出内固定后测量运动节段的活动度。分析手术并发症。结果结果:128例患者中97例获得随访,随访患者平均年龄(23.0±4.5)岁(17～36岁),均为男性。腰5峡部裂81例,腰4峡部裂13例,腰3峡部裂3例。术后6个月愈合41侧,双侧愈合17例;术后9个月愈合94侧,双侧愈合34例;术后12个月愈合159侧,双侧愈合72例,CT分型I型患者均愈合。术后1年愈合率为81.9%。术后24个月愈合率92.3%,其中15侧未愈合。双侧未愈合6例,均为CT分类中的III型。腰痛VAS评分由术前(7.2±2.1)分减轻为末次随访时的(1.3±0.4)分(P<0.05)。腰椎JOA评分自术前的(21.0±3.2)恢复到末次随访时的(27.6±1.0)(P<0.05)。术后1年取出内固定25例,运动节段平均活动度5.0°±2.7°。术后无脑脊液漏,无神经损伤,无术后感染并发症,切口延迟愈合3例。结论结论:峡部清理取髂骨植骨运动节段固定治疗青年腰椎峡部裂的融合率高,并发症发生率低,能够保留固定节段部分活动度,是一种可靠的方法。
Background: Lumbar spondylolysis is a common cause of low back pain in adolescents and also a risk factor forlate lumbar spondylolisthesis. Objective: To analyze the surgical results of lumbar isthmic spondylolysis by debridment andbone grafting with motion segment fixation. Methods: A retrospective analysis of 128 patients with lumbar spondylolysis treat-ed with isthmus debridement and iliac bone grafting from October 2013 to October 2015 was performed on patients with singlesegmental bilateral spondylolysis. The age, segmental distribution, pain level, and lower extremity radicular symptoms were an-alyzed. According to the CT results before operation, the isthmus was classified into type I line type, type II intermediate type,and type III sclerosis type. Postoperatively, the sagittal CT reconstruction was used to determine the healing condition. Continu-ous bony callus formation was the criterion for the isthmus healing and the healing time was recorded. After removing the inter-nal fixation, the motion of the motor segment were measured. Surgical complications were also analyzed. Results: Of the 128 patients, 97 male patients were followed up whose average age was 23.0±4.5 years(17-36 years). There were 81 patients of L5,13 patients of L4, and 3 patients of L3. There were 41 sides healed and 17 patients healed bilaterally in 6 months; 94 sideshealed and 34 patients healed bilaterally in 9 months; 159 sides healed and 72 patients healed bilaterally in 12 months. All pa-tients of CT type I were healed. The rate of healing was 81.9% after one year, and 92.3% in 24 months after operation. Therewere 15 sides unhealed. There were 6 patients with both sides unhealed, and all of them were type III by CT classification. TheVAS score of low back pain was reduced from preoperative(7.2±2.1) points to(1.3±0.4) points at the final follow-up(P<0.05). The lumbar JOA score was restored from(21.0±3.2) before operation to(27.6±1.0) at the final follow-up(P<0.05). Thefixation of 25 patients were removed one year after surgery, and the mean activity of the motor segment after removal of the in-ternal fixation was 5.0° ± 2.7°. No cerebrospinal fluid leakage, nerve injury, or postoperative infection complications werefound. There was delayed incision healing in 3 patients. Conclusions: It is reliable for lumbar spondylolysis to be treated by de-bridement of the isthmus, iliac bone grafting, and motion segmental fixation which is high in the fusion rate, has low incidenceof complications, and the activity of the fixed segment can be preserved.
Background: Lumbar spondylolysis is a common cause of low back pain in adolescents and also a risk factor forlate lumbar spondylolisthesis. Objective: To analyze the surgical results of lumbar isthmic spondylolysis by debridment andbone grafting with motion segment fixation. Methods: A retrospective analysis of 128 patients with lumbar spondylolysis treat-ed with isthmus debridement and iliac bone grafting from October 2013 to October 2015 was performed on patients with singlesegmental bilateral spondylolysis. The age, segmental distribution, pain level, and lower extremity radicular symptoms were an-alyzed. According to the CT results before operation, the isthmus was classified into type I line type, type II intermediate type,and type III sclerosis type. Postoperatively, the sagittal CT reconstruction was used to determine the healing condition. Continu-ous bony callus formation was the criterion for the isthmus healing and the healing time was recorded. After removing the inter-nal fixation, the motion of the motor segment were measured. Surgical complications were also analyzed. Results: Of the 128 patients, 97 male patients were followed up whose average age was 23.0±4.5 years(17-36 years). There were 81 patients of L5,13 patients of L4, and 3 patients of L3. There were 41 sides healed and 17 patients healed bilaterally in 6 months; 94 sideshealed and 34 patients healed bilaterally in 9 months; 159 sides healed and 72 patients healed bilaterally in 12 months. All pa-tients of CT type I were healed. The rate of healing was 81.9% after one year, and 92.3% in 24 months after operation. Therewere 15 sides unhealed. There were 6 patients with both sides unhealed, and all of them were type III by CT classification. TheVAS score of low back pain was reduced from preoperative(7.2±2.1) points to(1.3±0.4) points at the final follow-up(P<0.05). The lumbar JOA score was restored from(21.0±3.2) before operation to(27.6±1.0) at the final follow-up(P<0.05). Thefixation of 25 patients were removed one year after surgery, and the mean activity of the motor segment after removal of the in-ternal fixation was 5.0° ± 2.7°. No cerebrospinal fluid leakage, nerve injury, or postoperative infection complications werefound. There was delayed incision healing in 3 patients. Conclusions: It is reliable for lumbar spondylolysis to be treated by de-bridement of the isthmus, iliac bone grafting, and motion segmental fixation which is high in the fusion rate, has low incidenceof complications, and the activity of the fixed segment can be preserved.
引文
[1]李放,关凯,戴刚,等.椎弓根钉-椎板钩系统固定治疗单纯腰椎峡部裂.中国脊柱脊髓杂志, 2005, 15(11):9-11.
[2] Fredrickson BE, Baker D, McHolick WJ, et al. The natural history of spondylolysis and spondylolisthesis. J Bone JointSurg Am, 1984, 66(5):699-707.
[3] Sakai T, Sairyo K, Takao S, et al. Incidence of lumbar spondylolysis in the general population in Japan based on multide-tector computed tomography scans from two thousand sub-jects. Spine(Phila Pa 1976), 2009, 34(21):2346-2350.
[4] Sairyo K, Sakai T, Yasui N, et al. Conservative treatment forpediatric lumbar spondylolysis to achieve bone healing usinga hard brace:what type and how long?:Clinical article. JNeurosurg Spine, 2012, 16(6):610-614.
[5] Castro-Mateos I, Hua R, Pozo JM, et al. Intervertebral discclassification by its degree of degeneration from T2-weight-ed magnetic resonance images. Eur Spine J, 2016,25(9):2721-2727.
[6] Wiltse LL, Widell EH Jr, Jackson DW. Fatigue fracture:thebasic lesion is inthmic spondylolisthesis. J Bone Joint SurgAm, 1975, 57(1):17-22.
[7] Sairyo K, Katoh S, Sasa T, et al. Athletes with unilateral spon-dylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis:a clinical and biomechanicalstudy. Am J Sports Med, 2005, 33(4):583-590.
[8] Sairyo K, Katoh S, Sakamaki T, et al. Three successive stressfractures at the same vertebral level in an adolescent base-ball player. Am J Sports Med, 2003, 31(4):606-610.
[9] Mihara H, Onari K, Cheng CB, et al. The biomechanical ef-fects of spondylolysis and its treatment. Spine, 2003, 28(3):235-238.
[10] Sakai T, Tezuka F, Yamashita K, et al. Conservative treat-ment for bony healing in pediatric lumbar spondylolysis.Spine, 2017, 42(12):E716-E720.
[11] Wiltse LL, Newman PH, Macnab I. Classification of spondylo-lisis and spondylolisthesis. Clin Orthop Relat Res, 1976,(117):23-29.
[12]胥少汀.腰椎峡部裂与脊椎滑脱.中国矫形外科杂志,1994(02):103-105.
[2] Fredrickson BE, Baker D, McHolick WJ, et al. The natural history of spondylolysis and spondylolisthesis. J Bone JointSurg Am, 1984, 66(5):699-707.
[3] Sakai T, Sairyo K, Takao S, et al. Incidence of lumbar spondylolysis in the general population in Japan based on multide-tector computed tomography scans from two thousand sub-jects. Spine(Phila Pa 1976), 2009, 34(21):2346-2350.
[4] Sairyo K, Sakai T, Yasui N, et al. Conservative treatment forpediatric lumbar spondylolysis to achieve bone healing usinga hard brace:what type and how long?:Clinical article. JNeurosurg Spine, 2012, 16(6):610-614.
[5] Castro-Mateos I, Hua R, Pozo JM, et al. Intervertebral discclassification by its degree of degeneration from T2-weight-ed magnetic resonance images. Eur Spine J, 2016,25(9):2721-2727.
[6] Wiltse LL, Widell EH Jr, Jackson DW. Fatigue fracture:thebasic lesion is inthmic spondylolisthesis. J Bone Joint SurgAm, 1975, 57(1):17-22.
[7] Sairyo K, Katoh S, Sasa T, et al. Athletes with unilateral spon-dylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis:a clinical and biomechanicalstudy. Am J Sports Med, 2005, 33(4):583-590.
[8] Sairyo K, Katoh S, Sakamaki T, et al. Three successive stressfractures at the same vertebral level in an adolescent base-ball player. Am J Sports Med, 2003, 31(4):606-610.
[9] Mihara H, Onari K, Cheng CB, et al. The biomechanical ef-fects of spondylolysis and its treatment. Spine, 2003, 28(3):235-238.
[10] Sakai T, Tezuka F, Yamashita K, et al. Conservative treat-ment for bony healing in pediatric lumbar spondylolysis.Spine, 2017, 42(12):E716-E720.
[11] Wiltse LL, Newman PH, Macnab I. Classification of spondylo-lisis and spondylolisthesis. Clin Orthop Relat Res, 1976,(117):23-29.
[12]胥少汀.腰椎峡部裂与脊椎滑脱.中国矫形外科杂志,1994(02):103-105.