经Wiltse入路峡部植骨跨运动节段内固定治疗腰椎峡部裂

目的分析经Wiltse入路峡部植骨跨运动节段内固定治疗腰椎峡部裂的临床疗效。方法回顾性分析2014年10月-2016年10月采用经Wiltse入路峡部植骨跨运动节段内固定治疗的48例腰椎峡部裂患者临床资料。患者均为单节段双侧峡部裂。根据术前腰椎峡部裂CT表现分为3型,其中Ⅰ型(线型)15例,Ⅱ型(中间型)24例,Ⅲ型(硬化型)9例。根据术后影像学资料判断峡部裂愈合情况,并记录愈合时间及固定节段活动度。采用疼痛视觉模拟量表(VAS)评分评估腰部及髂骨取骨部位疼痛程度,采用日本骨科学会(JOA)评分评估腰椎功能。结果所有手术顺利完成。手术时间90~180 min,平均107 min;术中出血量50~160 mL,平均90 mL。随访6~36(15.3±3.8)个月,48例患者共96侧峡部裂,术后1年愈合率为86.5%,术后2年愈合率为94.8%,其中5侧未愈合,双侧未愈合2例,单侧未愈合1例,均为Ⅲ型患者。腰痛VAS评分由术前(6.9±2.7)分降至末次随访时(1.5±0.3)分,取髂骨部位疼痛VAS评分由术后1个月(3.7±1.3)分降至末次随访时(0.9±0.4)分,差异均有统计学意义(P<0.05)。腰椎JOA评分由术前(20.3±3.2)分恢复到末次随访时(26.9±1.0)分,差异有统计学意义(P<0.05)。术后1年22例患者取出内固定,取出后运动节段活动度为4°~10°(5.6°±2.3°)。切口延迟愈合1例,无脑脊液漏、神经损伤、感染等其他并发症发生。结论经Wiltse入路峡部植骨跨运动节段内固定治疗腰椎峡部裂,术中出血量小,愈合率高,是峡部裂修复手术中可尽量保留峡部血运的一种术式,值得临床推广。

Across motion segment internal fixation and isthmus bone grafting via Wiltse approach for treatment of lumbar spondylolysis

Objective To analyze the effect of across motion segment internal fixation and isthmus bone grafting via Wiltse approach for the treatment of lumbar spondylolysis.Methods From October 2014 to October 2016,the clinical data of 48 patients with lumbar spondylolysis treated with isthmic debridement,iliac bone grafting and across motion segment internal fixation via Wiltse approach were retrospectively analyzed,all of whom had bilateral spondylolysis of single segment.According to the preoperative CT,the spondylolysis was classified into typeⅠ(line type) in 15 cases,typeⅡ(intermediate type) in 24,and typeⅢ(sclerosis type) in 9.The healing condition of the spondylolysis was judged by imaging data after operation,and the healing time and range of motion were recorded.Visual analogue scale(VAS) score was used to evaluate the pain in the lower back and ilium bone extraction site,and Japanese Orthopaedic Association(JOA) score was used to evaluate lumbar function.Results All the operations were completed successfully.The operation time was 90-180 min,with an average of 107 min.Intraoperative blood loss was 50-160 mL,with an average of 90 mL.All the patients were followed up for 6-36(15.3±3.8)months.The healing rate of 48 patients with a total of 96 sides of spondylolysis was 86.5% at postoperative 1 year,and 94.8% at postoperative 2 years.Among them,5 sides failed to heal,including 2 suffered bilateral and 1 suffered unilateral failure of healing,all of them were Ⅲ type patients.The VAS score of low back pain decreased from 6.9±2.7 before operation to 1.5±0.3 at the final follow-up,and the VAS score of iliac pain decreased from 3.7±1.3 at postoperative 1 month to 0.9±0.4 at the final follow-up,both with statistically significant differences(P < 0.05).The JOA score was recovered from 20.3±3.2 before operation to 26.9±1.0 at the final follow-up,with a statistically significant difference(P < 0.05).At postoperative 1 year,internal fixation was removed in 22 patients,and the range of motion was 4°-10°(5.6°±2.3°).Delayed wound healing was observed in 1 case,and there was no cerebrospinal fluid leakage,nerve injury,infection and other complications.ConclusionAcross motion segment internal fixation and isthmus bone grafting via Wiltse approach for the treatment of spondylolysis,with small intraoperative blood loss and high healing rate,is a surgical method for preserving isthmus blood circulation as much as possible in the repair of spondylolysis,thus being worthy of clinical promotion.