Wiltse入路椎弓根钉-椎板钩内固定联合自体髂骨移植修复单节段腰椎峡部裂疗效分析  

Effect of Wiltse approach pedicle screw-laminar hook internal fixation combined with autologous ilium transplantation for repairing single-segment lumbar spondylolysis

作　　者：张涛 屈涛 刘华 李松凯 Zhang Tao;Qu Tao;Liu Hua;Li Song-Kai(Department of Spinal Surgery,the 940 Hospital of Joint Service Support Force of Chinese PLA,Lanzhou 730050,China)

机构地区：[1]解放军联勤保障部队第940医院脊柱外科,兰州730050

出　　处：《解放军医学杂志》2020年第7期761-766,共6页Medical Journal of Chinese People's Liberation Army

摘　　要：目的分析军队伤病员腰椎峡部裂的特点,探讨Wiltse入路椎弓根钉-椎板钩内固定联合自体髂骨移植修复军队伤病员单节段腰椎峡部裂的临床疗效。方法纳入2016年1月-2019年1月解放军第940医院收治的单节段腰椎峡部裂军队伤病员33例,采用Wiltse入路椎弓根钉-椎板钩内固定联合自体髂骨移植修复腰椎峡部裂,随访评估患者的腰部疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI),并与术前进行比较。行腰椎三维CT评估峡部植骨融合情况。结果陆军伤病员占所有病例的63.6%(21/33)。损伤节段均位于L4、L5,以L5节段(84.8%,28/33)最常见。手术时间85~150(106.8±17.4)min,术中出血量50~150(96.7±25.4)ml,术后引流量10~30(23.5±5.9)ml。术前腰痛VAS评分(5.8±0.7)分,术后3个月时降低至(1.4±0.8)分,末次随访时进一步降低至(0.4±0.5)分,差异均有统计学意义(P<0.05);术前ODI为41.2%±5.8%,术后3个月时降低至12.0%±3.9%,末次随访时进一步降低至9.5%±2.6%,差异均有统计学意义(P<0.05)。术后3、6、12个月随访时峡部植骨融合率分别为18.2%(6/33)、48.5%(16/33)、84.8%(28/33),植骨融合时间(7.0±2.8)个月。结论Wiltse入路椎弓根钉-椎板钩内固定联合自体髂骨移植修复军队伤病员单节段腰椎峡部裂是可行、有效的微创方案,且植骨融合时间较短。Objective To analyze the characteristics of lumbar spondylolysis in military patients,and explore the clinical effect of Wiltse approach pedicle screw-laminar hook internal fixation combined with autologous ilium transplantation in repairing singlesegment lumbar spondylolysis.Methods Thirty-three military patients with single-segment lumbar spondylolysis were admitted to the 940 Hospital of Joint Service Support Force of Chinese PLA from January 2016 to January 2019.The Wiltse approach pedicle screwlamina hook internal fixation combined with autogenous ilium transplantation was performed to repair the lumber spondylolysis,the patients were then followed up to evaluate the visual analogue scale(VAS)and Oswestry dysfunction index(ODI)of lumbar pain,and compared with that before surgery.3-D CT of lumbar spine was used to evaluate the bone graft fusion in the isthmus.Results The army patients accounted for 63.6%(21/33)of all the cases.The injured segments were located at L4 and L5 segment,with the L5 segment(84.8%,28/33)being the most common.The operation time was 85-150 min,the intraoperative blood loss was 50-150 ml,postoperative drainage volume was 10-30 ml.VAS score of lower back pain decreased from 5.8±0.7 before surgery to 1.4±0.8 three months after surgery,and to 0.4±0.5 at the last follow-up,the difference was statistically significant(P<0.05).ODI decreased from 41.2%±5.8%before surgery to 12%±3.9%3 months after surgery,and to 9.5%±2.6%at the last follow-up,the difference was statistically significant(P<0.05).At 3 months,6 months and 12 months follow-up,the bone graft fusion rate was 18.2%(6/33),48.5%(16/33)and 84.8%(28/33),respectively,and the average bone graft fusion time was 7.0±2.8 months.Conclusion Wiltse approach pedicle screw-laminar hook internal fixation combined with autogenous ilium transplantation is a feasible and effective minimally invasive solution for repairing single-segment lumbar spondylolysis of military patients with shorter bone graft fusion time.

关 键 词：Wiltse入路 军队伤病员 峡部裂 椎弓根钉-椎板钩内固定 

分 类 号：R687.3[医药卫生—骨科学]