改良腰骶角评估骨盆前倾复位技术在儿童重度L_5滑脱治疗中的应用  

Application of pelvic antevertion reduction evaluating by modifi ed lumbosacral angle for treatment of severe spondylolisthesis in children

作　　者：马振江[1] 赵长清[1] 田建平[1] 张凯[1] 孙晓江[1] 赵鑫[1] 李华[1] 赵杰[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院骨科,上海200011

出　　处：《脊柱外科杂志》2016年第1期21-25,共5页Journal of Spinal Surgery

基　　金：国家自然科学基金项目(81071453;81272038)

摘　　要：目的总结分析骨盆前倾复位技术在儿童重度L_5滑脱手术中的应用技巧,结合改良腰骶角（modified lumbosacral angle,m LSA）评估腰骶部畸形的纠正情况。方法回顾性分析2009年6月—2013年10月本院手术治疗的22例重度L_5滑脱（滑脱率〉50.0%）儿童患者的临床资料,其中男2例,女20例;年龄5~14岁,平均11.2岁;随访12~52个月,平均30个月。所有患者术中均予骨盆前倾复位技术复位滑脱椎体,纠正腰骶部后凸畸形。手术前后摄站立位全脊柱正侧位X线片,测量m LSA,评估椎体滑脱复位情况及后凸畸形纠正情况;行CT三维重建评估椎间融合情况;应用日本骨科学会（Japanese Orthopaedic Association,JOA）评分评估临床疗效。结果术后滑脱率1.0%~26.0%,平均7.45%,与术前相比差异具有统计学意义（P〈0.05）。m LSA术前为-（24.80°±8.42°）,改善至术后前凸20.40°±6.27°,末次随访时为前凸19.80°±5.17°;JOA评分由术前（7.68±1.55）分,改善至术后（16.68±1.66）分,末次随访时为（15.77±1.85）分,术前与术后评分差异具有统计学意义（P〈0.05）。术后1年植骨融合率95.45%;并发症发生率9.09%（2/22）,其中脑脊液漏1例,L_5神经根牵拉损伤1例。结论改良腰骶角测量评估骨盆前倾复位技术能有效复位滑脱椎体,纠正局部旋转畸形。Objective To investigate the technique of pelvic antevertion reduction by posterior approach for severe spondylolisthesis in children,and to evaluate the effect of vertebral reduction by modified lumbosacral angle（m LSA）. Methods From June 2009 to October 2013,a total of 22 children with severe spondylolisthesis of L_5/S1（slippage ratio50.0%）were treated with operative reduction,fixation and fusion through posterior approach. There were 2 males and 20 females at the mean age of 11.2 years（ranged 5-14 years） with a mean follow-up period of 30 months（ranged 12-52 months）. Through posterior approach all cases were treated with reduction of slipping vertebrae via pelvic antevertion for the correction of lumbosacral kyphosis. The efficacy of this technique in the reduction of local deformity and correction of lumbosacral kyphosis were assessed with m LSA through the pre- and post-operative whole spine standing anteroposterior and lateral roentgenographs. Bone fusion was assessed by followed-up 3D-CT reconstruction. Clinical outcomes were assessed by Japanese Orthopaedic Association（JOA） scores for low back pain and leg pain. Results The postoperative slippage ratio was 1.0%-26.0%,mean 7.45%. Compared with that of the preoperative,the difference was statistically significant（P 0.05）. The m LSA was improved from kyphotic-（24.80°±8.42°） before surgery to lordotic 20.40°±6.27° after surgery,and lordotic 19.80°±5.17° at final follow-up. JOA score was improved from 7.68±1.55 before surgery to 16.68±1.66 after surgery,and 15.77±1.85 at final follow-up. All data of postoperative and final follow-up had significant difference compared with those of preoperative（P 0.05）. Bone fusion rate was 95.45% by 3D-CT reconstruction at 12 months after operation. Complication rate was 9.09%（2/22）. One case was complicated by cerebrospinal fluid leakage and 1 case was observed nerve root paralysis in L_5. Conclusion The measurement of m LSA indicates a satisfactory reduction of slipping verteb

关 键 词：儿童 腰椎 脊椎滑脱 内固定器 脊柱融合术 

分 类 号：R726.851.33[医药卫生—儿科]