腰椎后路峡部植骨钉棒系统固定治疗青年腰椎双侧峡部裂疗效分析（临床论著）

蓝  云1、2，张建政2，孙天胜2

（1 南方医科大学第二临床医学院 363000 广州市；2 中国人民解放军总医院第七医学中心 100700 北京市）

基金项目：军队十二五课题面上项目（CBJ14J008）

第一作者简介：男（1991-），硕士在读，研究方向：脊柱外科

电话：（010）66721629  E-mail：1164266841@qq.com

通讯作者：孙天胜  E-mail：suntiansheng@136.com

【摘要】 目的：探讨腰椎后路峡部植骨钉棒系统固定治疗青年双侧腰椎峡部裂的疗效。方法：回顾性分析2015年10月~2017年10月我院收治的17例青年双侧腰椎峡部裂患者资料，男性13例，女性4例，年龄18~39（25.1±6.1）岁，病程12.7±8.8个月。其中L3节段1例，L5节段16例，致伤原因均为长期体育或军事等训练所致。所有患者均为单纯峡部裂，均采取双侧峡部髂骨植骨、椎弓根螺钉固定术治疗。术后随访12~18个月，平均15.4±2.0个月。通过腰椎CT评价峡部骨折愈合情况，通过腰部视觉模拟评分法（visual analogue score，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）评价临床疗效。随访期间腰椎CT证实峡部骨性愈合后行内固定取出。记录本组患者性别、年龄、病程、责任节段、致伤原因、合并伤、手术切口长度、手术时间、术中出血量、术前和末次随访时的腰椎CT责任节段峡部表现以及腰部VAS评分、脊柱ODI评分，并进行统计学分析。结果：手术切口长度9.1±2.1cm，手术时间168.5±46.4min，术中出血量108.8±61.8ml。所有患者手术切口无感染，均获得甲级愈合。17例患者末次随访时腰椎CT均可见腰椎滑脱恢复，峡部骨性愈合，均行内固定取出。术前、末次随访时，腰部VAS分别为5.8±1.1分和1.2±0.7分，脊柱ODI分别为（35.8±9.1）%和（7.1±2.0）%，差异有统计学意义（P<0.01）。末次随访时有2例患者剧烈活动时偶有腰部疼痛，不影响正常生活。随访期内均无断钉、内固定松动和邻近节段退变等不良并发症。结论：腰椎后路峡部植骨钉棒系统固定治疗青年双侧腰椎峡部裂是一种安全且有效的方法。

【关键词】 双侧腰椎峡部裂；长期训练；钉棒系统；手术

doi：10.3969/j.issn.1004-406X.2019.08.06

中图分类号：R681.5，R687.3    文献标识码：A   文章编号：1004-406X（2019）-08-0712-05

Therapeutic effect analysis of posteriorlumbar isthmus bone grafting and screw-rod system fixation for bilateral lumbarspondylolysis in youths/LAN Yun, ZHANG Jianzheng, SUN Tiansheng//ChineseJournal of Spine and Spinal Cord, 2019, 29(8): 712-716

【Abstract】 Objectives: To investigate the effects of posterior lumbar isthmusscrew-rod system fixation and local bone grafting in the treatment of bilaterallumbar spondylolysis in youths. Methods: Data of 17 patients with bilaterallumbar spondylolysis admitted to our hospital from October 2015 to October 2017were retrospectively analyzed, including 13 males and 4 females, aged 18-39(25.1±6.1) years, with an average course of 12.7±8.8 months. Among them, 1 case with L3spondylolysis, and the other 16 cases with L5 spondylolysis, and all werecaused by long-term sports or military training. All patients were simplespondylolysis. All patients were treated with iliac bone grafting and pediclescrew fixation. The follow-up period ranged from 12 to 18 months, with anaverage of 15.4±2.0 months. The fusion status of isthmic was evaluated by lumbar CTscan, and the clinical outcome was evaluated by visual analogue score(VAS) andspinal Oswestry disability index(ODI). During the follow-up period, implant wasremoved after CT scan confirming the isthmus fusion. Gender, age, diseasecourse, fixed level, cause of injury, combined injuries, incision length,operation time, intra-operative bleeding volume, the CT manifestation ofisthmus before operation and at final follow-up, VAS of lumbar spine and ODI ofspinal column were collected and analyzed. Results: The average age of 17patients was 25.1±6.1 years, there were 13 males and 4 females, 16 L5 segments and 1L3 segments. All patients were followed up for an average of 15.4±2.0 months.The course of disease was 12.7±8.8 months. All of them are simple isthmicfissures. The injuries were caused by long-term sports or military training.The incision was 9.1±2.1cm, the operation time was 168.5±46.4min, intra-operativebleeding volumewas 108.8±61.8ml. No infection was found in the incision of all the patients,and grade A healing was achieved. At final follow-up, lumbar spondylolisthesisrecovered and isthmus bone healed in all 17 patients, with implant removedduring the follow-up. The preoperative and final follow-up VAS scores were 5.8±1.1 and 1.2±0.7 respectively, and the ODI scores were (35.8±9.1)% and (7.1±2.0)%, respectively(P<0.01). At finalfollow-up, 2 patients had occasional low back pain during intense activities,which did not influence their normal life. No implant breakage, implantloosening and adjacent segments degeneration were found during the follow-up.Conclusions: Posterior lumbar isthmus bone grafting and screw-rod systemfixation is an effective and safe method in the treatment of bilateral lumbarspondylolysis in youths.

【Key words】 Bilateral spondylolysis; Long-term training; Screw-rod system; Surgery

【Author′s address】 Second Clinical Medical College of SMU, Guangzhou, 363000, China

图1  患者男，19岁 a~c 术前腰椎侧位、后伸位和双斜位片示峡部L5峡部骨皮质不连续图 d、e 术前腰椎MRI，可见脊髓神经无明显受压，L5峡部不连续 f、g 术后腰椎侧位片和腰椎CT示峡部植骨、L5-S1钉棒系统固定术后改变 h~j 分别为术后10、12和15个月腰椎CT平扫示L5峡部愈合过程中骨痂等变化，峡部有骨小梁通过，骨性融合 k 内固定取出后腰椎CT平扫示内固定物无残留，峡部骨皮质连续

Figure1  The patient was a 19-year-old male a-cPreoperative lumbar lateral, posterior extension and oblique positionsradiographs, respectively. Discontinuity of cortical bone at L5 par interarticularcould be seen d, e Preoperative lumbar MR images, showed no significantcompression of spinal nerves and discontinuity of the lumbar isthmus f, g  Posterior radiographs and CT scansrespectively. The changes in isthmus bone grafting and L5-S1 screw-rod systemfixation were observed h-j CT scans of the lumbar spine at 10, 12 and 15 monthsafter operation, showed changes in callus with bone trabecula passing throughthe isthmus and bone healing at L5 par k CT scans of the lumbar spine takenafter removal of the hardwares showed continuous isthmus cortex

本文为删节版，原文见《中国脊柱脊髓杂志》2019年8月刊