单侧双通道内镜下修复青年战士腰椎峡部裂  

Repair of lumbar spondylolysis with unilateral biportal endoscopic in young soldiers

作　　者：刘勇[1] 程智涛[1] 胡阿威[1] Liu Yong;Cheng Zhitao;Hu Awei(First-Class Surgery of Hubei Provincial Corps Hospital of CPAPF,Wuhan Hubei,430061,China)

机构地区：[1]武警湖北省总队医院骨科,湖北武汉430061

出　　处：《生物骨科材料与临床研究》2023年第3期32-35,共4页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的探讨单侧双通道脊柱内镜技术(UBE)下修复结合经皮椎弓根钉内固定治疗青年战士腰椎峡部裂的手术技术及初步临床效果。方法回顾性分析2019年3月至2021年2月期间,武警湖北省总队医院骨科收治的18例青年武警战士腰椎峡部裂患者,术前影像学检查明确诊断,均为单纯型峡部裂或伴有轻度椎体滑脱,有明显下腰痛症状,严重影响生活及训练,无神经压迫症状及体征,经半年以上保守治疗效果不佳。采用UBE下峡部裂处清理,取髂骨植骨,经皮椎弓根钉固定,有滑脱者进行复位。术后3个月、6个月、1年门诊随访,采用视觉模拟评分(VAS)评价腰痛情况,Oswestry功能障碍指数(ODI)评价功能改善情况,并进行CT检查判断峡部愈合情况。结果所有患者均顺利完成手术,无严重手术并发症。腰痛VAS评分由术前(5.5±1.2)分减少至术后1年时(1.2±0.4)分,术前、术后1年比较差异有统计学意义(P<0.05);ODI评分由术前(25.1±1.3)分减少至术后1年时(5.4±1.6)分,术前、术后1年比较差异有统计学意义(P<0.05)。末次随访依据改良MacNab标准评价疗效,优14例,良3例,可1例,差0例,优良率为94.44%。腰椎CT示峡部裂植骨均骨性愈合,愈合后手术取出内固定。结论UBE下清理植骨结合经皮椎弓根钉固定治疗青年战士腰椎峡部裂,手术方式微创,愈合率高,效果好,技术可行。Objective To investigate the surgical technique and preliminary clinical effect of lumbar spondylolysis repair in young soldiers under UBE combined with percutaneous pedicle screw fixation.Methods A total of 18 young soldiers with lumbar spondylolysis were treated in Hubei Provincial Corps Hospital of CPAPF from March 2019 to February 2021,the diagnosis was confirmed by imaging examination before operation,all patients were simple lumbar spondylolysis or with mild spondylolisthesis,obvious symptoms of low back pain,seriously affect life and training,no symptoms and signs of nerve compression,after more than half a year of conservative treatment,the effect was poor.Clean up lumbar spondylolysis with UBE,iliac bone graft,with percutaneous pedicle screw fixation,with slippage should be reset.Patients were followed up at 3 months,6 months and 1 year after the operation.VAS was used to evaluate back pain.ODI was used to assess disability function,and CT scan was used to assess healing status.Results All patients successfully completed the operation without serious complications.The VAS score of low back pain decreased significantly from(5.5±1.2)scores before operation to(1.2±0.4)scores at the last follow-up(P<0.05).The ODI score decreased significantly from(25.1±1.3)scores before operation to(5.4±1.6)scores at the last follow-up(P<0.05).At the last follow-up,the curative effect was evaluated according to MacNab standard,14 cases were excellent,3 cases were good,1 case was fair,0 case was poor,the excellent and good rate was 94.44%.CT showed that all the bone grafts of isthmus healed,and the internal fixation was removed after healing.Conclusion Repair of lumbar spondylolysis with unilateral biportal endoscopic technique in young soldiers,the operation method is minimally invasive,the healing rate is high,the effect is good,and the technique is feasible.

关 键 词：单侧双通道脊柱内镜技术 经皮椎弓根钉 修复 青年战士 腰椎峡部裂 

分 类 号：R681.5[医药卫生—骨科学]