摘要
目的:根据青年战士腰椎峡部裂临床特点及影像学表现进行分型,根据不同分型采用不同手术方式,评价治疗效果及并发症.方法:回顾性分析2010年3月~2016年12月期间,我科收治的青年战士腰椎峡部裂患者326例.均为男性,年龄18~36岁,平均22.4±5.1岁.根据临床特点和影像学表现将所有病例分为3型,A型为单纯型峡部裂,无椎间盘突出及腰椎滑脱;B型为峡部裂伴有轻度椎间盘突出或Ⅰ度滑脱,无神经压迫症状及体征;C型为峡部裂合并Ⅰ度或Ⅱ度滑脱并椎间盘突出同时有神经压迫症状及体征.影像学检查:术前均进行腰椎正侧位、左右斜位、站立位全长正侧位X线片,腰椎CT及矢状位重建,腰椎MRI检查.腰椎X线片观察腰椎峡部裂位置及滑脱情况,腰椎CT明确峡部裂的程度及位置.腰椎MRI观察腰椎间盘突出及神经压迫情况.手术方法:A型或B型病例采用椎弓根钉固定,有滑脱进行复位,清理峡部,取髂骨峡部原位植骨.C型病例采用后路椎板减压,椎间盘切除,椎间植骨融合椎弓根螺钉内固定术.术后半年、1年、1年半门诊随访,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.术后半年,1年,1年半,2年及以后进行CT及矢状位重建判断峡部愈合情况.结果:A型和B型病例共305例,C型21例.283例得到随访,通过平均20.0±7.8个月的随访,VAS由术前的平均5.6±1.1分降至终末随访的1.1±0.3分,ODI由术前的平均25.2±3.2分降至末次随访的5.3±1.7分.术后半年复查CT发现,A和B型病例峡部裂愈合252例,愈合率91%(252/278),平均愈合时间12个月,愈合后再次手术取出内固定.椎间植骨病例无需取出内固定.结论:青年战士A、B型腰椎峡部裂病例采用椎弓根螺钉固定,峡部自体髂骨原位植骨融合率高,效果好,C型战士峡部裂则宜采用后路椎间植骨融合椎弓根螺钉内固定术.
Objectives:To classify lumbar spondylolysisin young soldiers according to the clinical features and imaging findings,and evaluate the therapeutic outcome and complications of different surgical methods.Methods:From March 2010 to December 2016,326 cases of young soldiers with lumbar spondylolysis were admitted into our department.All were male,with an average age of 22.4±5.1 years(18-36 years).All patients were divided into three types according to clinical features and imaging findings as follows:Type A,simplex spondylolysis,no disc herniation or slippage;type B,spondylolysis with mild intervertebral disc herniation or degreeⅠslippage,without nerve compression symptoms and signs;type C,spondylolysis with degreeⅠorⅡslippage and intervertebral disc herniation and accompanied with nerve compression symptoms and signs.Preoperative lumbar spine AP and lateral radiographs,left and right oblique radiographs,full-length standing AP and lateral radiographs,lumbar CT scan and sagittal reconstruction,and lumbar MRI were performed.The position of spondylolysis were evaluated using lumbar X-ray,and the diagnosis and position of spondylolysis were determined based on lumbar CT.Lumbar disc herniation and nerve compression status were assessed using MRI.Operation method:type A or type B cases were treated with pedicle screw fixation,slip reduction and in situ bone graft fusion.Type C cases were treated with posterior decompression and intervertebral disc excision,intervertebral bone graft fusion with pedicle screw fixation.Patients were followed up at 6 months,1 year,18 months and then every year after the operation.VAS was adopted to evaluate back pain.Lumbar disability function was evaluated with ODI.CT and sagittal reconstruction were performed at 6 months,one year,18 months,and 2 years after the operation.Results:Type A and type B include 305 cases,type C 21 cases.A total of 283 cases were followed up.At an average follow-up of 20.0±7.8 months,the average VAS was decreased from 5.6±1.1 points before surgery to 1.1±
作者
赵广民
王俊峰
李放
张志成
关凯
ZHAO Guangmin;WANG Junfeng;LI Fang(Department of Orthopeadics,the 7th Medical Center of PLA Army General Hospita,Beijing,100700,China)
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2019年第11期984-989,共6页
Chinese Journal of Spine and Spinal Cord
关键词
腰椎峡部裂
分型
青年战士
峡部修复
Lumbar pondylolysis
Direct repair
Young soldier
Classification
