Wiltse入路Quadrant通道下植骨内固定术修复青少年峡部裂  

Pars repair by internal fixation and bone graft through the Wiltse approach via Quadrant channel

作　　者：都文楠 郑修军[1] 刘小臻[2] 柳翔云[1] 孙元亮[1] 寇建强[1] 

机构地区：[1]青岛大学附属医院骨科,266003 [2]青岛大学附属医院儿科注射室,266003

出　　处：《中华骨科杂志》2014年第9期930-935,共6页Chinese Journal of Orthopaedics

摘　　要：目的 探讨Wiltse入路Quadrant通道下植骨内固定治疗青少年峡部裂的临床疗效.方法 2007年11月至2011年4月,采用Wiltse入路Quadrant通道下峡部裂修复自体髂骨植骨及椎弓根螺钉-椎板钩系统内固定治疗青少年峡部裂11例,男10例,女1例;年龄15～19岁,平均（17.3±1.3）岁.病程6～14个月,平均（9.9±2.0）个月.病变节段均为L5.术前X线及三维CT检查证实峡部无明显骨痂通过,断端有硬化.4例患者伴有Ⅰ度腰椎滑脱.腰椎MR检查证实所有患者椎间盘退变Pfirrmann分级均为Ⅰ级.随访时评估患者腰部疼痛视觉模拟评分（visual analogue scale,VAS）和Oswestry功能障碍指数（Oswestry disability index,ODI）,并与术前评估进行比较.行X线和三维CT检查评估峡部裂愈合情况.结果 手术时间为70～110 min,平均（85.5±12.3） min;术中出血量为80～150 ml,平均（105±19.4） ml.2例失随访,其余9例随访12～24个月,平均16个月.术后腰痛症状明显缓解,腰部疼痛VAS评分由术前（4.5±1.0）分降至末次随访的（1.5±1.0）分,差异有统计学意义（t=4.603,P=0.002）;ODI由术前49.3％±14.2％降至末次随访时的12.0％±4.9％,差异有统计学意义（t=7.344,P=0.000）.9例患者Macnab分级优7例、良2例.经三维CT检查证实双侧峡部均获骨性愈合,愈合时间12～24个月,平均16个月.结论 经Wiltse入路Quadrant通道椎弓根螺钉-椎板钩内固定修复峡部裂可有效保护椎旁肌,缓解患者疼痛症状,改善功能.Objective To investigate the clinical effects of pars repair by the pedicle screws,laminal hooks and auto iliac bone graft through the Wiltse approach via Quadrant channel for the treatment of the adolescent spodylolysis.Methods From November 2007 to April 2011,pars defects of 11 patients （10 males and 1 female） were repaired with pedicle screws,laminal hooks and auto iliac bone graft via Quadrant channel through the Wiltse approach.The mean age of 11 patients was 17.3 years （range 15-19）.Mean course was 9.9 months （range 6-14 months）.All patients have bilateral pars defect of L5.There was no poroma across the pars that have been proved by X-ray film and 3-D CT before the operation.There were 4 patients with Ⅰ grade spondylolisthesis.The degeneration of the intervertebral disc assessed by Pfirrmann grade of all patients was no more than Ⅰ grade.Visual analogue scale （VAS） and Oswestry disability index （ODI） were compared before and after operation.The fusion of pars defect was observed by X-ray film and 3-D CT.Results The mean operation time was 85.5±12.3 min （range 70-110 min）; intraoperatve blood loss was 80-150 ml （mean 105 ± 19.4 ml）.Two patients were lost in follow-up after operation and the others had been followed up for 12 to 24 months （mean 16 months）.All patients had significant pain relief and function recovery after operation.Mean postoperative VAS score was 1.5± 1.0 compared with 4.5± 1.0 of preoperation （t=4.603,P=0.002）.ODI was decreased from 49.3％± 14.2％ of preoperation to 12.0％±4.9％ of the last follow-up （t=7.344,P=0.000）.With the Macnab grades,7 patients are excellent,2 patients are good.3-D CT showed that all pars defect were fused in the last follow-up.Conclusion Pars repair by the pedicle screws,laminal hooks and auto iliac bone graft through the Wiltse approach via Quadrant channel can protect the paravertebral muscle,relief patients from pain,and improve function.

关 键 词：青少年 外科手术 微创性 脊椎滑脱 

分 类 号：R726.8[医药卫生—儿科]