峡部植骨修补联合临时单节段钉棒固定治疗青少年腰椎峡部裂  

Bone graft to repair isthmus defect plus temporary single segmental screw rod fixation for adolescent lumbar spondylolysis

作　　者：屈巍[1] 黄云飞[1] 宋宗让[1] 吴起宁[1] 王宇飞[2] 

机构地区：[1]西安交通大学医学院附属红会医院脊柱外科,陕西省西安市710054 [2]西安交通大学医学院附属红会医院骨科,陕西省西安市710054

出　　处：《中国组织工程研究》2017年第11期1707-1711,共5页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金资助项目(81301604)~~

摘　　要：背景:腰椎峡部裂是引起青少年腰痛的常见原因,保守治疗无效时多采用内固定治疗,方式多种多样,目的是消除疼痛,达到峡部充分的骨性融合。目的:观察峡部植骨修补联合椎弓根钉棒系统临时单节段固定治疗青少年腰椎峡部裂的临床效果。方法:应用峡部植骨修补联合椎弓根钉棒系统临时单节段固定治疗青少年腰椎峡部裂症患者32例,所有患者双侧峡部断裂,其中无滑脱型20例,Ⅰ度滑脱12例。内固定前行腰椎X射线、CT及MRI检查,内固定前及内固定后行目测类比评分及Oswestry功能障碍指数评分观察患者疼痛改善情况,采用MacN ab评价疗效。内固定后随访行腰椎CT检查观察患者峡部植骨愈合情况。骨愈合后行内固定取出,观察患者固定节段的活动度及相邻节段椎间盘退变情况。结果与结论:(1)所有患者均获得峡部骨性愈合,平均愈合时间为7.4个月;(2)所有患者腰痛目测类比评分和Oswestry功能障碍指数评分较内固定前明显改善(P<0.05)。(3)取出内固定后,观察发现临时固定节段的腰椎活动度保留,MRI检查示固定节段的相邻椎间盘信号均较内固定前无明显改变;(4)结果说明,峡部修补单节段椎弓根钉棒临时固定可有效治疗青少年腰椎峡部裂,峡部骨性愈合确切,临时固定可有效避免临近节段椎间盘退变产生。BACKGROUND： Lumbar spondylolysis is the common cause of teenagers＆#39; low back pain. It should apply internal fixation if conservative treatment is invalid. There are a variety of surgeries, which aims to alleviate pain and bony fusion of pars defect.OBJECTIVE： To observe clinical outcome of bone graft of pars defect plus temporary single segmental pedicle screw rod fixation for adolescent lumbar spondylolysis.METHODS： A total of 32 adolescent patients of lumbar spondylolysis were treated by bone graft of pars defect plus temporary single segmental pedicle screw rod fixation. All the patients had bilateral spondylolysis. 20 patients had no lumbar spondylolisthesis, while the others had I＆#176; spondylolisthesis. All the patients received lumbar radiograph, CT and MRI. Visual analogue scale and Oswestry disability index were utilized to evaluate pain improvement before and after operation. MacNab was used to assess efficacy. Bone graft healing at isthmus was observed with lumbar CT after fixation. The internal fixation was removed after bone fusion, then the motion of the fixed segment and the degeneration of adjacent intervertebral disc occurred were recorded.RESULTS AND CONCLUSION： （1） Completed bone fusion of pars defect was achieved in all the patients. The average period of bone union was 7.4 months. （2） The visual analogue scale and Oswestry disability index scores were significantly improved after surgery in all patients （P 〈 0.05）. （3） The fixed segment reserved the motion after internal fixation removal. The signal of adjacent intervertebral disc of fixed segment had no changes compared to preoperative MRI. （4） Bone graft to repair isthmus defect plus temporary single segmental screw rod fixation for adolescent lumbar spondylolysis is very effective, the bone fusion is completed, and temporary fixation may effectively alleviate the degeneration of adjacent disc.

关 键 词：骨科植入物 脊柱植入物 单节段固定 峡部修补 临时固定 椎弓根钉棒固定系统 非融合 青少年峡部裂 国家自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]