临时固定联合骨诱导活性材料植骨治疗腰椎峡部裂临床分析  

Temporary fixation combined with osteoinductive absorbing material bone graft for lumbar spondylolysis

作　　者：张锴 陈书连 高延征 邢帅 曹臣 王耀斌 刘利民 ZHANG Kai;CHEN Shulian;GAO Yanzheng;XING Shuai;CAO Chen;WANG Yaobin;LIU Limin(Department of Spinal and Spinal Cord Surgery,Henan University People's Hospital,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南大学人民医院河南省人民医院脊柱脊髓外科,郑州450003

出　　处：《中华实用诊断与治疗杂志》2020年第11期1135-1138,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技重点攻关项目(201502024);河南省科技厅基础与前沿项目(1221102310145)。

摘　　要：目的探讨单节段临时固定联合局部骨诱导活性材料植骨治疗腰椎峡部裂的临床效果,为临床治疗腰椎峡部裂提供参考。方法腰椎峡部裂患者15例,其中无滑脱型12例,Ⅰ度滑脱3例,均行单节段临时固定联合局部骨诱导活性材料植骨术治疗。观察术后临床症状改善情况、双侧峡部融合时间等,并于峡部融合后取出内固定。随访18个月,比较术前及末次随访时患者Oswestry功能障碍指数、视觉模拟评分及固定节段椎间活动度,观察病椎及相邻上位椎间盘退变情况,评价临床治疗效果。结果15例患者手术过程均顺利,术后患者腰骶部疼痛症状明显改善,3例Ⅰ度滑脱均复位。双侧峡部骨性融合时间为(5.2±0.8)个月。末次随访时患者视觉模拟评分[(1.5±1.0)分]、Oswestry功能障碍指数[(11.2±2.9)%]均低于术前[(6.6±1.3)分、(68.4±13.8)%](P<0.05),椎间活动度[(7.9±1.9)°]与术前[(8.1±2.2)°]比较差异无统计学意义(P>0.05);相邻上位椎间盘未出现退变;临床疗效优12例,良3例。结论单节段临时固定联合骨诱导活性材料植骨术治疗腰椎峡部裂疗效确切,可保留病变节段腰椎活动度,避免相邻节段椎间盘退变。Objective To investigate the clinical outcome of temporary single segmental pedicle screw fixation combined with osteoinductive absorbing material bone graft of pars defect in the treatment of lumbar spondylolysis,and to provide reference for clinical treatment of lumber spondylolysis.Methods Fifteen patients with lumbar spondylolysis including 12 patients with no lumbar spondylolisthesis and 3patients with degreeⅠspondylolisthesis were performed bone graft of pars defect plus temporary single segmental pedicle screw fixation.The relieving of clinical symptoms and bilateral isthmic fusion time were observed,and internal fixator was removed after isthmic fusion.All patients were followed up for 18 months.The Oswestry disability index,visual analogue scale and fixed segment activity were compared before operation and at the final follow-up.The degeneration of intervertebral disc in the diseased vertebra and adjacent segments was observed.The operation outcomes were evaluated.Results All patients completed operation successfully.The lumbosacral pain was significantly alleviated,and degreeⅠlumbar spondylolisthesis in 3patients was restored after operation.The bilateral isthmus bone fusion time was(5.2±0.8)months.Visual analogue scale score and Oswestry disability index at the final follow-up were lower(1.5±1.0,(11.2±2.9)%)than those before operation(6.6±1.3,(68.4±13.8)%)(P<0.05),intervertebral activity showed no significant difference after operation((7.9±1.9)°)compared with that before operation((8.1±2.2)°)(P>0.05).The adjacent upper disc degeneration was not observed.The clinical effect was excellent in 12 patients and good in 3.Conclusion Temporary fixation combined with osteoinductive absorbing material bone graft achieves definite effect in the treatment of lumbar spondylolysis,and it can preserve the activity of the diseased segments,and avoid the degeneration of intervertebral discs in adjacent segments.

关 键 词：腰椎峡部裂 单节段固定 峡部修补 骨诱导活性材料 椎弓根钉 非融合 

分 类 号：R687.3[医药卫生—骨科学]