节段内V形棒内固定技术联合峡部植骨融合治疗青少年腰椎峡部裂的疗效观察  

Analysis of surgical outcome of intra-segmental V-shaped rod technique combined with isthmus bone graft fusion for lumbar spondylolysis in adolescent

作　　者：方贤聪 刘伟 王振林 程继伟 吕鹏 赵宏 幸永明 王杰 FANG Xiancong;LIU Wei;WANG Zhenlin;CHENG Jiwei;LV Peng;ZHAO Hong;XING Yongming;WANG Jie(Department of Orthopaedics,PLA 906 Hospital,Ningbo,Zhejiang 315040,China;不详)

机构地区：[1]中国人民解放军联勤保障部队第九〇六医院脊柱外科,浙江宁波315040 [2]同济大学附属同济医院脊柱外科,上海200065

出　　处：《中国骨与关节损伤杂志》2023年第3期243-246,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的 探讨节段内V形棒内固定技术联合峡部植骨融合治疗青少年腰椎峡部裂的手术方法和疗效。方法 回顾性分析自2016-10—2020-02采用节段内V形棒内固定技术联合峡部植骨融合治疗的31例青少年腰椎峡部裂,其中单节段峡部裂24例,双节段峡部裂6例,三节段峡部裂1例。共39个峡部裂腰椎,其中A型28个,B型6个,C型5个。A型和B型峡部裂椎体采用节段内V形棒内固定技术联合峡部植骨融合,C型峡部裂椎体采用常规椎体间植骨融合内固定。结果 31例均获得随访,随访时间1.0~3.5年,平均1.4年。术后3个月、6个月、12个月疼痛VAS评分和ODI指数均较术前明显改善,差异有统计学意义(P<0.05)。术后1年随访时,除了5个C型峡部裂椎体行椎间融合术外,其余34个腰椎双侧峡部裂(共计68个峡部裂断面)中25个椎体双侧融合,7个椎体单侧融合,2个椎体未融合,峡部裂融合率为83.8%(57/68)。结论 节段内V形棒内固定技术联合峡部植骨融合治疗青少年腰椎峡部裂可避免腰椎节段间融合或固定,可保留腰椎节段活动度,具有创伤小、神经损伤风险小、术后腰椎稳定性好、植骨融合率高等优点。Objective To analyze the surgical treatment and therapeutic effect of intra-segmental V-shaped rod fixation tech-nique combined with isthmus bone graft fusion in the treatment of lumbar spondylolysis in adolescent.Methods Thirty-one adolescent lumbar spondylolysis patients treated with intra-segmental V-shaped rod fixation technique combined with isthmus bone graft fusion from October 2016 to February 2020 were retrospectively analyzed.Single segment spondylolysis was in 24 cases,double segment spondylolysis in 6 cases,and three segment spondylolysis in 1 case.There were 39 spondylolysis verte-brae in all patients,including 28 type A vertebrae,6 type B vertebrae,and 5 type C vertebrae.Spondylolysis vertebrae with type A and B were operated with segmental V-rod internal fixation combined with isthmus fusion,while spondylolysis verte-brae with type C were operated with conventional intervertebral fusion internal fixation.ResultsThe follow-up time was 1.0-3.5 years,with an average of 1.4 years.VAS scores and ODI scores at 3,6 and 12 months after operation were significantly im-proved compared with those before operation,and there were statistical dfferences(P<0.05).In addition to 5 C-type spondylol-ysis vertebrae undergoing intervertebral fusion,there were 25 bilateral fusion,7 unilateral fusion and 2 no-fusion in the re-maining 34 vertebrae(68 spondylolysis sections)at 1-year follow-up.The spondylolysis fusion rate was about 83.8%(57/68).Conclusion Intra-segmental V-shaped rod fixation technique combined with isthmus bone graft fusion in the treatment of lumbar spondylolysis in adolescents may avoide segmental lumbar fusion or fixation and retained the lumbar segmental mobili-ty,which has the advantages of less trauma,less risk of nerve injury,better immediate postoperative stability,and higher rate of bone graft fusion.

关 键 词：腰椎峡部裂 峡部植骨融合 V形棒技术 青少年 

分 类 号：R687.3[医药卫生—骨科学]