青年腰椎峡部裂内镜与开放植骨固定比较  

Endoscopic versus open bone grafting and pedicle screw fixation for lumbar isthmic spondylolysis in youth

作　　者：文永亮 覃海飚[2] 覃浩然[2] 陈勇喜[2] 宋泉生[2] 粱健[1] 杨剑[1] 陈丽娴 WEN Yong-li-ang;QIN Hai-biao;QIN Hao-ran;CHEN Yong-xi;SONG Quan-sheng;LIANG Jian;YANG Jian;CHEN Li-xian(Graduate school,Guangxi University of Traditional Chinese Medicine,Nanning 530000,China;Department of Spinal Surgery,The First Affiliated Hospital,Guangxi University of Traditional Chinese Medicine,Nanning 530000,China)

机构地区：[1]广西中医药大学研究生学院,广西南宁530000 [2]广西中医药大学第一附属医院脊柱外科,广西南宁530000

出　　处：《中国矫形外科杂志》2024年第1期75-79,共5页Orthopedic Journal of China

摘　　要：[目的]比较内镜与开放峡部植骨联合椎弓根螺钉固定青年腰椎峡部裂的临床疗效。[方法]回顾性分析2017年6月—2021年1月本科收治的22例腰椎峡部裂患者的临床资料,根据医患沟通结果,12例采用内镜手术,10例采用开放手术,比较两组临床与影像结果。[结果]内镜组术中出血量[(115.8±13.1)ml vs(195.0±27.2)ml,P<0.05]、下地时间[(1.3±0.5)d vs(2.3±0.5)d,P<0.05]和住院时间[(10.1±1.2)d vs(14.1±1.8)d,P<0.05]均显著优于开放组,但前者手术时间[(115.1±11.2)min vs(100.6±7.3)min,P<0.05]显著长于后者。随访时间平均(14.8±2.2)个月,术后随时间推移,两组VAS评分及ODI均显著减少(P<0.05),术前两组间VAS评分、ODI的差异均无统计学意义(P>0.05),术后1、3个月内镜组的VAS评分、ODI显著优于开放组(P<0.05),但末次随访时,两组上述评分的差异均无统计学意义(P>0.05)。影像方面,随时间推移,两组峡部愈合显著增加(P<0.05),相应时间点,两组患者峡部愈合质量与峡部愈合时间的差异均无统计学意义(P>0.05),末次随访后,所有患者均达到峡部骨性愈合。[结论]后路内镜下峡部植骨联合椎弓根钉固定术治疗青年腰椎峡部裂的临床疗效优于传统开放术式。[Objective]To compare the clinical outcomes of endoscopic versus open bone grafting and pedicle screw fixation for lumbaristhmic spondylolysis in the youth.[Methods]A retrospective study was conducted on 22 patients who received surgical treatment for lum-bar isthmic spondylolysis in our department from June 2017 to January 2021.According to the preoperative doctor-patient communication,12 patients underwent the endoscopic surgery,while other 10 patients underwent the open surgery.The clinical and imaging consequencesof the two groups were compared.[Results]The endoscopic group proved significantly superior to the open group in terms of intraoperativeblood loss[(115.8±13.1)ml vs(195.0±27.2)ml,P<0.05],postoperative ambulation time[(1.3±0.5)days vs(2.3±0.5)days,P<0.05]and hospi-tal stay[(10.1±1.2)days vs(14.1±1.8)days,P<0.05],but the former consumed significantly longer operation time than the latter[(115.1±11.2)min vs(100.6±7.3)min,P<0.05].With time of the follow-up period lasted for(14.8±2.2)months on a mean,the VAS score and ODI sig-nificantly decreased in both groups(P<0.05),which was not statistically significant between the two groups before surgery(P>0.05),whilethose in the endoscopic group were significantly better than the open group 1 and 3 months after surgery(P<0.05),and then became not sta-tistically significant again between the two groups at the latest follow-up(P>0.05).Radiographically,the isthmic healing rate increased sig-nificantly over time in both groups(P<0.05),with no significant differences in isthmic healing quality and isthmic healing time between thetwo groups at any time points accordingly(P>0.05).By the time of last follow-up,all patients achieved isthmic bone healing.[Conclusion]The posterior endoscopic isthmic bone grafting and pedicle screw fixation is considerably better than the traditional open counterpart for lum-bar isthmic spondylolysis.

关 键 词：腰椎峡部裂 自体骨移植 内镜术 椎弓钉固定 

分 类 号：R687[医药卫生—骨科学]