摘要
目的探讨V型钛缆结合椎弓根钉内固定系统治疗青年第五腰椎(L5)峡部裂的近期临床疗效。方法回顾性分析2018年1月—2019年6月新疆军区总医院收治的37例应用Ⅴ型钛缆结合椎弓根钉内固定系统治疗的青年L5峡部裂患者的临床资料。患者均为男性,年龄18~34(25.19±4.92)岁,手术前腰痛时间5~60(21.62±13.01)个月,峡部裂伴椎体滑脱(Meyerding分类Ⅰ度)8例、单纯性峡部裂29例,术前MR检查Pfirrmann分级Ⅰ级20例、Ⅱ级10例、Ⅲ级7例。观察患者手术时间、术中出血量、伤口引流量、并发症;定期随访,比较患者术前及术后3、6、12个月疼痛视觉模拟评分法(VAS)、Oswsetry功能障碍指数(ODI)、骨盆入射角(PI),末次随访采用MacNab标准评价疗效,并评估内固定失效及峡部愈合情况。结果所有患者随访12~24(16.21±3.97)个月,术中未出现腰椎节段动脉破裂、硬膜囊撕裂及神经脊髓损伤等严重并发症,术后均未发生手术部位感染。手术时间(89.19±24.45)min、术中出血量(137.84±58.79)mL、术后伤口引流量(98.65±43.47)mL。患者术后不同时间点与术前比较,腰腿痛VAS评分和ODI均较术前显著降低,差异均有统计学意义(F=332.470、287.029,P值均<0.01),而PI差异均无统计学意义(F=0.868,P>0.05)。随访终末期:MacNab疗效评价优19例、良15例、可2例、差1例,优良率91.89%(34/37);内固定失效2例,失效率5.41%(2/37);峡部骨性愈合33例,愈合率89.19%(33/37)。结论应用V型钛缆结合椎弓根钉内固定系统治疗青年L5峡部裂,在椎间盘损伤不大或合并轻微滑脱的腰椎峡部裂患者中手术安全性好,整体优良率及峡部愈合率较高,内固定失效率较低,可作为一种新的手术方式为临床提供参考。
Objective To investigate the short-term clinical efficacy of V-type titanium cable internal fixation in the treatment of young fifth lumbar spondylolysis.Methods Retrospective analysis was performed on the clinical data of young fifth lumbar spondylolysis admitted to Xinjiang General Hospital from January 2018 to June 2019.Thirty-seven patients were treated with V-type titanium cable internal fixation.All patients were males,aged 18-34(25.19±4.92)years.The time of anterior lumbago was 5-60(21.62±13.01)months.Of the 37 patients,8 had lumbar spondylolysis accompanied by vertebral body spondylolysis(Meyerding classification degree I)and 29 had simple isthmus.Preoperative MRI examination showed that the Pfirrmann grading of the patients was as follows:20 cases of gradeⅠ,10 cases of gradeⅡ,and 7 cases of gradeⅢ.The operative time,intraoperative blood loss,wound drainage,and complications were observed and recorded.The visual analog scale(VAS),Oswsetry disability index(ODI),and pelvic incidence(PI)were analyzed at regular follow-up before and 3,6,and 12 months after surgery.Macnab efficacy criteria were used to evaluate the failure of internal fixation and spondylolysis fusion in the final follow-up.Results All patients were followed up for 12-24(16.21±3.97)months.No serious complications,such as lumbar segmental artery rupture,dural sac tear,and nerve and spinal cord injury,were observed.In addition,no postoperative wound had surgical site infection.The operative time was(89.19±24.45)min,the intraoperative blood loss was(137.84±58.79)mL,and the postoperative wound drainage was(98.65±43.47)mL.The VAS and ODI scores of lumbar and leg pain were significantly lower than those before surgery at different times(F=332.470,287.029,all P values<0.01).No significant change in PI was observed,and the differences were not statistically significant(F=0.868,P>0.05).At the end of follow-up,19 cases were excellent,15 cases were good,2 cases were fair,and 1 case was poor,with an excellent and good rate of 91.89%(34/37);2 c
作者
马锐
安伟
徐斌
马在松
李强
杨新明
阿不都艾孜孜·麦麦提
滕勇
Ma Rui;An Wei;Xu Bin;Ma Zaisong;Li Qiang;Yang Xinming;Abduaziz Mamat;Teng Yong(Department of Spine Section of Orthopaedic Trauma,General Hospital of Xinjiang Military Region,Urumqi 830000,China)
出处
《中华解剖与临床杂志》
2021年第5期517-521,共5页
Chinese Journal of Anatomy and Clinics
基金
新疆维吾尔自治区区域协同创新专项计划(2019E0277)。
关键词
腰椎
峡部裂
青年人
Lumbar
Spondylolysis
Young adult
