钉棒系统固定结合峡部植骨融合治疗青少年腰椎峡部裂远期疗效

目的：探讨腰椎后路椎弓根钉固定结合峡部植骨融合治疗青年腰椎峡部裂远期疗效。

方法：回顾性分析自2006年1月至2014年7月收治16例采用腰椎后路椎弓根钉固定结合峡部植骨融合术治疗的单纯腰椎峡部裂不伴有腰椎滑脱的青年患者，其中男11例，女5例；年龄18~21岁，平均19.3岁；病程12~26个月，平均22个月。所有患者存在活动后腰部疼痛，严重者下床活动困难，术前CT证实L₅峡部裂12例，L₄峡部裂4例，并在术后影像学证实植骨融合后取出内固定。采用腰痛视觉模拟评分法对术前、术后各时间点进行评分，采用腰椎CT检查评估腰椎峡部融合情况，采用腰椎MRI检查评估固定节段及邻近节段腰椎间盘退变情况。

结果：本组16例患者，13例26侧获得完整随访，平均96个月；手术时间80~105 min，平均95 min；术中出血量150~300 ml，平均225 ml。所有患者手术顺利完成，无手术相关并发症发生；患者术后各时间点VAS评分较术前改善（P<0.01）。术后腰椎CT检查均获骨性融合，融合时间6~14个月，平均12个月；腰椎MRI检查无邻近节段退变及固定节段间盘变性、突出等改变，术后远期无症状复发及再发峡部裂。

结论：采用腰椎后路椎弓根钉固定结合峡部植骨融合治疗青年腰椎峡部裂，该术式安全、有效，融合率高，减少对正常生理活动范围的干扰，长期疗效满意。

Long term outcome of posterior lumbar pedicle screw fixation combined with isthmic bone graft fusion in the treatment of lumbar spondylolysis in young patients

Objective: To investigate the long-term effect of posterior lumbar pedicle screw fixation combined with isthmus bone grafting and fusion in young patients with spondylolysis.

Methods: A retrospective study was carried out,consisting of 16 young patients with lumbar spondylolysis without spondylolisthesis treated by lumbar posterior pedicle screw fixation combined with isthmic bone grafting fusion from January 2006 to July 2014. There were 11 males and 5 females,aged from 18 to 21 years old,with an average age of 19.3 years old,and the course of disease ranged from 12 to 26 months,with an average of 22 months. All the patients suffered from lumbar pain and difficulty in getting out of bed. Preoperative CT confirmed 12 cases of L₅ isthmus fissure and 4 cases of L₄ isthmus fissure. Bone graft fusion was confirmed and internal fixation was removed after operation. Lumbar spondylolysis was evaluated by lumbago visual analogue scoring method at preoperative and postoperative time points. Lumbar isthmic fusion was evaluated by lumbar CT,and degeneration of fixed and adjacent segments of lumbar intervertebral disc was evaluated by lumbar MRI.

Results: Of the 16 patients,13 patients (26 sides) were followed up,with a mean duration of 96 months. The operation time ranged from 80 to 105 minutes,with an average of 95 minutes. The intraoperative bleeding volume ranged from 150 to 300 ml,with an average of 225 ml. All the patients were successfully operated without any complications related to the operation. VAS scores at each time point after operation were improved compared with those before operation(P<0.01). Postoperative CT scans of lumbar spine showed osseous fusion at 6 to 14 months,with an average of 12 months. There were no changes of adjacent segment degeneration,fixed segment disc degeneration and protrusion on lumbar spine MRI,and no symptomatic recurrence or recurrent spondylolysis in the long term.

Conclusion: The posterior lumbar pedicle screw fixation combined with isthmic bone grafting and fusion is safe and effective in the treatment of young spondylolysis. The fusion rate is high and the interference of normal physiological range is reduced. The long-term effect is satisfactory.