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月于本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,接受手术时平均年龄(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,随访(45.2±11.8)个月。其中4例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。
Objective To evaluate the clinical outcomes of hook-pedicle-screw technique in adolescents with lumbar isthmus spondylolysis. Methods From December 2006 to October 2015,a total of 7 patients undergoing hook-pedicle-screw fixation plus bone grafting for spondylolysis were retrospectively studied.There were 5 males and 2 females with an average age of(20.1±4.2)years.All of them underwent posterior spondylolysis repairing with hook-screw fixation plus bone grafting.Medical history and clinical data were recorded and lumbar radiographs evaluated at pre-operation and post-operation.Computed tomography(CT)sagittal reconstructions were evaluated at the final follow-up and symptoms and complications were recorded. Results The average operative duration was(105.1±29.3)min and the average volume of blood loss(90.0±53.5)mL.The average follow-up period was(45.2±11.8)months.The MacNab scores were excellent(n=4),good(n=2)and fair(n=1).All of them had pain relief.Lumbar radiographs and CT sagittal reconstructions showed hook-screw was located at a right place and bone healing occurred in all cases.There was only one case of implant-related complication. Conclusion For adolescents with lumbar isthmus spondylolysis,hook-pedicle-screw fixation plus bone grafting is both safe and effective for repairing.Those failed cases of conservative measures should be operated as early as possible.
