Zhou Chengyao,Zhang Jianguo,Wang Shengru,et al.Efficacy of hook-screw fixation for lumbar isthmus spondylolysis in adolescents[J].Journal of Clinical Pediatric Surgery,2018,17(09):669-672.
应用椎弓根螺钉-椎板钩系统行青年腰椎峡部裂修补术的临床疗效分析
- Title:
- Efficacy of hook-screw fixation for lumbar isthmus spondylolysis in adolescents
- Keywords:
- youth; spondylolysis; pedicle screw; hook; bone grafting
- 文献标志码:
- A
- 摘要:
- 目的 初步评估应用椎弓根螺钉-椎板钩系统行腰椎峡部裂修补术治疗青年腰椎峡部裂的临床效果。方法 以2006年12月至2015年10月于我院接受后路椎弓根螺钉-椎板钩辅助峡部裂修补术的7例（男性5例，女性2例）青年峡部裂患者为研究对象，平均年龄（20.1 ± 4.2）岁，均采用“后路峡部裂修补+椎弓根螺钉+椎板钩内固定+髂骨取骨植骨术”联合治疗的方案。同时收集患者术前及术后时刻腰椎正侧位X线片、末次随访时刻CT矢状重建片、临床表现及手术并发症等资料。结果 7例患者手术平均时间为（105.1 ± 29.3）min，出血量（90.0 ± 53.5）mL（80 ~ 155mL），随访（45.2 ± 11.8）个月（36 ~ 120个月）。其中4例患者MacNab评分等级为非常好，2例评分等级为好，1例评分等级为中等。7例患者术后腰痛等症状均得到明显缓解，腰椎X线片及CT矢状重建确认所有患者示内固定位置良好，双侧峡部裂处均已达到骨性愈合。随访过程中1例出现钉钩植入相关并发症。结论 椎弓根螺钉-椎板钩系统原位植骨修复青年腰椎峡部裂安全有效，对于保守治疗无效的患者应早期进行手术。
- Abstract:
- Objectives To evaluate the clinical outcomes of hook-pedicle-screw technique in the youth’ spondylolysis. Methods 7 patients (5 males, 2 females) undergoing hook-pedicle-screw fixation and bone grafting for spondylolysis in our hospital from December 2006 to October 2015 were retrospectively studied. The average age is 20.1±4.2 (16-27)years. All the patients underwent posterior spondylolysis repair with hook-screw fixation and bone grafting. The medical history and clincal information were recorded and lumbar radiographs were evaluated at pre-operation and post-operation. CT sagittal reconstructions were evaluated at final follow-up and symptoms and complications were recorded. Results The mean operation time was 105.1±29.3min, with 90.0±53.5mL average blood loss. The mean time for the follow-up period is 45.2±11.8(36-120) months. MacNab scores showed 4 cases “excellent”, 2 cases “good” and 1 case “fair”. All patients got pain relief. Lumbar radiographs and CT sagittal reconstructions showed hook-screw at right place and bone healing in all cases. Only one complication occurred in all cases, which was implant-related. Conclusion For young patients with spondylolysis, hook-pedicle-screw fixation and bone grafting is a safe and effective operation procedure for the repairment. Repairment by operation is recommended for patients with no response to conservative treatment.
参考文献/References:
1 Debusscher F, Troussel S. Direct repair of defects in lumbar spondylolysis with a new pedicle screw hook fixation: clinical, functional and Ct-assessed study[J]. Eur Spine J, 2007,16(10):1650-1658. DOI: 10.1007/s00586-007-0392-0.. 2 Farfan HF, Osteria V, Lamy C. The mechanical etiology of spondylolysis and spondylolisthesis[J]. Clin Orthop Relat Res, 1976,(117):40-55. PubMed PMID: 1277685. 3 Standaert CJ, Herring SA. Spondylolysis: a critical review[J]. Br J Sports Med,2000;34(6):415-422. PubMed PMID: 11131228. 4 Kimura M. My method of filing the lesion with spongy bone in spondylolysis and spondylolistesis[J]. Seikei Geka. 1968,19(4):285-96. PubMed PMID: 5693611. 5 Hefti F, Seelig W, Morscher E. Repair of lumbar spondylolysis with a hook-screw[J]. Int Orthop, 1992,16(1):81-85. PubMed PMID: 1572778. 6 Dai LY, Jia LS, Yuan W, et al. Direct repair of defect in lumbar spondylolysis and mild isthmic spondylolisthesis by bone grafting, with or without facet joint fusion[J]. Eur Spine J, 2001,10(1):78-83. PubMed PMID: 11276840. 7 Buck JE. Direct repair of the defect in spondylolisthesis. Preliminary report[J]. J Bone Joint Surg Br, 1970,52(3):432-437. PubMed PMID: 4916960. 8 Lu J, Ebraheim NA, Biyani A, et al Screw placement in the lumbar vertebral isthmus. Clin Orthop Relat Res, 1997,(338):227-230. PubMed PMID: 9170384. 9 Nicol RO, Scott JH. Lytic spondylolysis. Repair by wiring. Spine (Phila Pa 1976). 1986;11(10):1027-1030. PubMed PMID: 3554554. 10 Louis R. Pars interarticularis reconstruction of spondylolysis using plates and screws with grafting without arthrodesis. Apropos of 78 cases [J]. Rev Chir Orthop Reparatrice Appar Mot, 1988,74(6):549-557. PubMed PMID: 3070652. 11 Morscher E, Gerber B, Fasel J. Surgical treatment of spondylolisthesis by bone grafting and direct stabilization of spondylolysis by means of a hook screw. Arch Orthop Trauma Surg, 1984,103(3):175-178. PubMed PMID: 6497607. 12 Fan J, Yu GR, Liu F, et al. Direct repair of spondylolysis by TSRH’s hook plus screw fixation and bone grafting: biomechanical study and clinical report. Arch Orthop Trauma Surg, 2010,130(2):209-215. DOI: 10.1007/s00402-009-0897-6. 13 Gillet P, Petit M. Direct repair of spondylolysis without spondylolisthesis, using a rod-screw construct and bone grafting of the pars defect[J]. Spine (Phila Pa 1976), 1999,24(12):1252-1256. PubMed PMID: 10382254. 14 Shin MH, Ryu KS, Rathi NK, et al. Direct pars repair surgery using two different surgical methods : pedicle screw with universal hook system and direct pars screw fixation in symptomatic lumbar spondylosis patients[J]. J Korean Neurosurg Soc,2012,51(1):14-19. DOI: 10.3340/jkns.2012.51.1.14. 15 Karatas AF, Dede O, Atanda AA, et al. Comparison of Direct Pars Repair Techniques of Spondylolysis in Pediatric and Adolescent Patients: Pars Compression Screw Versus Pedicle Screw-Rod-Hook[J]. Clin Spine Surg,2016,29(7):272-280. DOI: 10.1097/BSD.0b013e318277cb7d. 16 Smith JA, Hu SS. Management of spondylolysis and spondylolisthesis in the pediatric and adolescent population[J]. Orthop Clin North Am,1999,30(3):487-499. PubMed PMID: 10393770. 17 Arnold P, Winter M, Scheller G, et al. Clinical and radiological isthmus reconstruction in lumbar spondylolysis and minimal spondylolisthesis[J]. Z Orthop Ihre Grenzgeb,1996,134(3):226-232.DOI: 10.1055/s-2008-1039753. 18 Szypryt EP, Twining P, Mulholland RC, et al. The prevalence of disc degeneration associated with neural arch defects of the lumbar spine assessed by magnetic resonance imaging[J]. Spine (Phila Pa 1976),1989,14(9):977-981. PubMed PMID: 2789436.