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,2024,(01):72-76.[doi:10.3760/cma.j.cn101785-202204068-014]
腰椎滑脱复位融合内固定术治疗儿童重度发育不良性腰椎滑脱的临床疗效及影像学分析
- Title:
- 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
- 摘要:
- 目的 评估腰椎滑脱复位融合内固定术治疗儿童重度发育不良性腰椎滑脱(high dysplastic developmental spondylolisthesis,HDDS)的临床疗效及影像学参数变化特征。 方法 回顾性分析2014年1月至2019年12月于首都医科大学附属北京儿童医院行腰椎滑脱复位融合内固定术的29例重度腰椎滑脱患儿临床资料,其中男性2例、女性27例,年龄(9.9±2.6)岁,术前滑脱Meyerding分度为Ⅲ度16例、Ⅳ度9例、Ⅴ度4例。记录患儿术前、术后3个月及术后2年时的腰椎滑脱率、矢状面轴向垂直距离(sagittal vertical axis,SVA)、胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、骨盆投射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、滑脱角(slip angle,SA)等指标。采用疼痛视觉模拟评分(visual analogue scale,VAS)及日本骨科协会(Japanese Orthopaedic Association,JOA)评分评估患儿腰腿痛和腰椎功能改善情况。 结果 29例均顺利完成手术,术后随访时间2年及以上,平均随访时间(31.8±10.9)个月。患儿SVA[术前比术后3个月为(37.8±21.5)°比(21.1±8.2)°]、LL[术前比术后3个月为(52.2±19.3)°比(34.5±11.7)°]、PT[术前比术后3个月为(39.4±14.0)°比(26.4±8.2)°]、SS[术前比术后3个月为(27.8±10.7)°比(35.2±7.9)°]、SA[术前比术后3个月为(26.4±14.4)°比(10.7±5.2)°]均较术前显著改善(P<0.05);TK[术前比术后3个月为(14.4±9.3)°比(15.5±5.4)°]、PI[术前比术后3个月为(67.3±12.5)°比(61.6±10.9)°]较术前无明显变化(P＞0.05)。SVA[术后3个月比术后2年为(21.1±8.2)°比(19.9±8.2)°]、TK[术后3个月比术后2年为(15.5±5.4)°比(20.1±7.5)°]、PT[术后3个月比术后2年为(26.4±8.2)°比(30.7±11.4)°]、SS[术后3个月比术后2年为(35.2±7.9)°比(41.0±11.0)°]和SA[术后3个月比术后2年为(10.7±5.2)°比(10.6±6.0)°]均无明显变化(P＞0.05),LL[术后3个月比术后2年为(34.5±11.7)°比(46.3±11.8)°]和PI[术后3个月比术后2年为(61.6±10.9)°比(71.7±13.8)°]明显增大(P<0.05)。术后2年时VAS评分由术前(5.6±1.1)分降至(0.4±0.2)分(t=17.030,P<0.05),JOA评分由术前(11.9±2.9)分升至(20.4±2.8)分(t=-17.972,P<0.05),有效率达96.6%。2例术后出现神经刺激症状,1例出现伤口皮下积液,对症治疗后均恢复良好,无一例发生内固定失效。末次随访时平均滑脱复位率为(82.6±6.7)％,脊柱融合率为100％。 结论 腰椎滑脱复位融合内固定术治疗HDDS临床疗效满意,可有效重建脊柱-骨盆矢状面平衡,值得临床推广应用。
- 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.
参考文献/References:
[1] Tsirikos AI,Garrido EG.Spondylolysis and spondylolisthesis in children and adolescents[J].J Bone Joint Surg Br,2010,92(6):751-759.DOI:10.1302/0301-620X.92B6.23014.
[2] Mehdian SH,Arun R.A new three-stage spinal shortening procedure for reduction of severe adolescent isthmic spondylolisthesis:a case series with medium-to long-term follow-up[J].Spine(Phila Pa 1976),2011,36(11):E705-E711.DOI:10.1097/BRS.0b013e3182158c1f.
[3] Marchetti PG,Bartolozzi P.Classification of spondylolisthesis as a guideline for treatment[M]//Bridwell KH,DeWald RL,Hammerberg KW,et al.The Textbook of Spinal Surgery.2nd ed.Philadelphia:Lippincott-Raven,1997:1211-1254.
[4] Lamartina C,Zavatsky JM,Petruzzi M,et al.Novel concepts in the evaluation and treatment of high-dysplastic spondylolisthesis[J].Eur Spine J,2009,18(Suppl 1):133-142.DOI:10.1007/s00586-009-0984-y.
[5] Mac-Thiong JM,Hresko MT,Alzakri A,et al.Criteria for surgical reduction in high-grade lumbosacral spondylolisthesis based on quality of life measures[J].Eur Spine J,2019,28(9):2060-2069.DOI:10.1007/s00586-019-05954-x.
[6] Jiang GY,Ye CY,Luo JY,et al.Which is the optimum surgical strategy for spondylolisthesis:reduction or fusion in situ? A meta-analysis from 12 comparative studies[J].Int J Surg,2017,42:128-137.DOI:10.1016/j.ijsu.2017.04.066.
[7] Hoel RJ,Brenner RM,Polly DWJr.The challenge of creating lordosis in high-grade dysplastic spondylolisthesis[J].Neurosurg Clin N Am,2018,29(3):375-387.DOI:10.1016/j.nec.2018.03.006.
[8] Martiniani M,Lamartina C,Specchia N."In situ" fusion or reduction in high-grade high dysplastic developmental spondylolisthesis(HDSS)[J].Eur Spine J,2012,21(Suppl 1):S134-S140.DOI:10.1007/s00586-012-2230-2.
[9] Bourassa-Moreau ?,Mac-Thiong JM,Joncas J,et al.Quality of life of patients with high-grade spondylolisthesis:minimum 2-year follow-up after surgical and nonsurgical treatments[J].Spine J,2013,13(7):770-774.DOI:10.1016/j.spinee.2013.01.048.
[10] Porto AB,Okazaki VHA.Thoracic kyphosis and lumbar lordosis assessment by radiography and photogrammetry:a review of normative values and reliability[J].J Manipulative Physiol Ther,2018,41(8):712-723.DOI:10.1016/j.jmpt.2018.03.003.
[11] Hresko MT,Labelle H,Roussouly P,et al.Classification of high-grade spondylolistheses based on pelvic version and spine balance:possible rationale for reduction[J].Spine(Phila Pa 1976),2007,32(20):2208-2213.DOI:10.1097/BRS.0b013e31814b2cee.
[12] Zhou XY,Zhao J,Li B,et al.Assessment of sagittal spinopelvic balance in a population of normal Chinese children[J].Spine(Phila Pa 1976),2020,45(13):E787-E791.DOI:10.1097/BRS.0000000000003428.
[13] Roussouly P,Nnadi C.Sagittal plane deformity:an overview of interpretation and management[J].Eur Spine J,2010,19(11):1824-1836.DOI:10.1007/s00586-010-1476-9.
[14] Labelle H,Mac-Thiong JM,Roussouly P.Spino-pelvic sagittal balance of spondylolisthesis:a review and classification[J].Eur Spine J,2011,20(Suppl 5):641-646.DOI:10.1007/s00586-011-1932-1.
[15] Gutman G,Silvestre C,Roussouly P.Sacral doming progression in developmental spondylolisthesis:a demonstrative case report with two different evolutions[J].Eur Spine J,2014,23(Suppl 2):288-295.DOI:10.1007/s00586-014-3306-y.
[16] Fujimori T,Okuda S,Iwasaki M,et al.Validity of the Japanese orthopaedic association scoring system based on patient-reported improvement after posterior lumbar interbody fusion[J].Spine J,2016,16(6):728-736.DOI:10.1016/j.spinee.2016.01.181.
[17] Chiarotto A,Maxwell LJ,Ostelo RW,et al.Measurement properties of visual analogue scale,numeric rating scale,and pain severity subscale of the brief pain inventory in patients with low back pain:a systematic review[J].J Pain,2019,20(3):245-263.DOI:10.1016/j.jpain.2018.07.009.
备注/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