Zhao Mengqi,Qi Xinyu,Liu Haonan,et al.Clinical outcomes and radiographic measurements of posterior reduction and internal fixation with bone graft fusion for children with high dysplastic developmental spondylolisthesis[J].Journal of Clinical Pediatric Surgery,,():72-76.[doi:10.3760/cma.j.cn101785-202204068-014]
Clinical outcomes and radiographic measurements of posterior reduction and internal fixation with bone graft fusion for children with high dysplastic developmental spondylolisthesis
- Keywords:
- Dysplastic; Lumbar Spondylolisthesis; Radiographic Parameters; Surgical Treatment; Clinical Outcome
- Abstract:
- Objective To explore the clinical effect and radiographic features of posterior reduction and internal fixation with bone graft fusion for children with high dysplastic developmental spondylolisthesis(HDDS).Methods A total of 29 HDDS children undergoing lumbar spondylolisthesis surgery were recruited from January 2014 to December 2019.There were 2 boys and 27 girls with a mean age of(9.9±2.6)years.According to the Meyerding classification scheme,clinical grades were Ⅲ(n=16),Ⅳ(n=9)and Ⅴ(n=4).Spinal parameters were recorded pre-operation and at Month 3/24 post-operation,including lumbar spondylolisthesis rate,sagittal vertical axis(SVA),thoracic kyphosis(TK),lumbar lordosis(LL),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS)and slip angle(SA).Clinical outcomes were evaluated by visual analogue scale(VAS)and Japanese Orthopaedic Association(JOA)score.Results All procedures were completed successfully.All of them were followed up for over 2 years with a mean period of(31.8±10.9)months.The relevant measurements were SVA[pre-operation vs Month 3 post-operation(37.8±21.5)° vs.(21.1±8.2)°],LL[pre-operation vs Month 3 post-operation(52.2±19.3)° vs.(34.5±11.7)°],PT[pre-operation vs Month 3 post-operation(39.4±14.0)° vs.(26.4±8.2)°],SS[pre-operation vs Month 3 post-operation(27.8±10.7)° vs.(35.2±7.9)°]and SA[pre-operation vs Month 3 post-operation(26.4±14.4)° vs.(10.7±5.2)°],There were significant improvements as compared with pre-operation(P<0.05),No significant changes occurred in TK(pre-operation vs Month 3 post-operation 14.4±9.3° vs.15.5±5.4°)or PI(67.3±12.5° vs.61.6±10.9°)(P>0.05).SVA[Month 3 vs. Year 2 post-operation were(21.1±8.2)° vs.(19.9±8.2)°],TK[Month 3 vs. Year 2 post-operation(15.5±5.4)° vs.(20.1±7.5)°],PT[Month 3 vs. Year 2 post-operation(26.4±8.2)° vs.(30.7±11.4)°],SS[Month 3 vs. Year 2 post-operation(35.2±7.9)° vs.(41.0±11.0)°]and SA[Month 3 vs. Year 2 post-operation(10.7±5.2)° vs.(10.6±6.0)°]showed no marked changes(P>0.05).LL[Month 3 vs. Year 2 post-operation(34.5±11.7)° vs.(46.3±11.8)°]and PI［Month 3 vs. Year 2 post-operation(61.6±10.9)° vs.(71.7±13.8)° changed markedly(P<0.05).At Year 2 post-operation,VAS score dropped from pre-operation(5.6±1.1)to(0.4±0.2)(t=17.030,P<0.05)and JOA score spiked from pre-operation(11.9±2.9)to(20.4±2.8)(t=-17.972,P<0.05).Improvement rate of JOA score was 96.6%.In this cohort,the complications were nerve root stimulation symptoms(n=2)and wound effusion(n=1).All of them recovered after conservative measures.No internal fixation failure occurred.The mean lumbar spondylolisthesis rate and fusion rate was(82.6±6.7)% and 100% at the final follow-up.Conclusions Posterior reduction and internal fixation with bone graft fusion is both effective and safe for HDDS children.A wider clinical popularization is warranted.
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Memo
收稿日期:2022-4-22。
基金项目:中央高水平医院临床科研业务费资助(2022—PUMCH—D—004)
通讯作者:张学军,Email:zhang-x-j04@163.com