微创通道下节段间经皮椎弓根螺钉内固定术并自体髂骨植骨治疗青年L5峡部裂

目的探讨微创通道下节段间经皮椎弓根螺钉内固定术并自体髂骨植骨治疗青年L5峡部裂的临床疗效。方法回顾性分析2013年3月—2015年9月接受节段间经皮椎弓根螺钉内固定术并自体髂骨植骨治疗的22例青年L5峡部裂患者临床资料。采用疼痛视觉模拟量表(VAS)评分评价患者腰痛改善情况。所有患者术前,术后3、6、9和12个月均行腰椎正侧位、动力位、双斜位X线检查,术后6、9和12个月复查腰椎矢状位CT重建,评价峡部植骨融合情况及腰椎活动度。结果所有手术均顺利完成。患者随访6~36个月,平均13.2个月。22例患者共44处峡部裂,39处植骨融合,植骨融合时间为6~12个月,平均10.7个月;3例单侧未融合,1例双侧未融合,植骨融合率为88.6%。腰痛VAS评分,术前为(7.00±0.84)分,末次随访时改善至(1.20±0.81)分。术前、术后6个月、内固定器取出后的L5/S1椎间活动度分别为10.3°±2.4°,8.7°±3.0°和9.5°±2.8°。结论微创通道下节段间经皮椎弓根螺钉内固定术并自体髂骨植骨治疗青年L5峡部裂,避免了常规开放手术对椎旁肌的广泛剥离,可促进患者早期恢复,疗效确切。

Minimally invasive percutaneous pedicle screw fixation and autologous iliac bone grafting for treatment of L5 spondylolysis in young patients

Objective To investigate the clinical effect of minimally invasive percutaneous pedicle screw fixation and autologous iliac bone grafting for treatment of L₅ spondylolysis in young patients. Methods From March 2013 to September 2015, the clinical data of 22 young patients with L₅ spondylolysis treated by minimally invasive percutaneous pedicle screw fixation and autologous iliac bone grafting were analyzed retrospectively. The visual analogue scale (VAS) score was used to evaluate the improvement of low back pain. The anteroposterior, lateral, dynamic and oblique roentgenographs at pre-operation, postoperative 3, 6, 9 and 12 months, and sagittal CT reconstruction at postoperative 6, 9 and 12 months were used to evaluate isthmic fusion condition and lumbar range of motion. Results All the operations were successfully completed. All the patients were followed up for 6-36 months, with an average of 13.2 months. There were 44 sites of spondylolysis in 22 patients, and 39 of them got bone graft fusion. The fusion time ranged 6-12 months (average 10.7 months); 3 patients had unilateral non-fusion and 1 bilateral non-fusion; the fusion rate was 88.6%. The VAS score of low back pain was 7.00±0.84 before operation and increased to 1.20±0.81 at the final follow-up. The range of motion in L₅/S₁ was 10.3°±2.4°, 8.7°±3.0° and 9.5°±2.8° at pre-operation, postoperative 6 months and after removal of internal fixator, respectively. Conclusion Minimally invasive percutaneous pedicle screw fixation and autologous iliac bone grafting in the treatment of young L₅ spondylolysis avoids extensive dissection of paravertebral muscles by conventional open surgery, which can promote early recovery of patients with definite curative effect.