摘要
目的比较"双稳定构型"椎弓及椎板钉固定法与改良Scott法治疗青少年症状性腰椎峡部裂的疗效。方法回顾性分析2017年1月至2021年10月中国人民解放军联勤保障部队第九〇〇医院骨二科因症状性腰椎峡部裂就诊并手术治疗的64例患者资料。男59例,女5例;年龄(24.9±5.2)岁;责任椎体:L32例,L410例,L547例,L4~L55例;伴滑脱9例。依据手术方式不同分为"双稳定构型"椎弓及椎板钉固定法(观察组,31例)与改良Scott法(对照组,33例)。比较两组患者手术时间、术中出血量、术后引流量、峡部愈合率、内固定失效率,比较两组患者术后1、3个月、末次随访时腰痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分、JOA评分优良率等,并观察并发症的发生情况。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者均获随访,观察组患者手术时间[(94.7±14.9)min]显著长于对照组[(84.4±16.4)min],差异有统计学意义(P=0.011);但两组患者术中出血量、术后引流量比较差异均无统计学意义(P>0.05)。观察组双侧峡部愈合率93.5%(29/31)显著高于对照组60.6%(20/33)、内固定失效率(0)显著低于对照组(12.1%,4/33),差异均有统计学意义(P<0.05)。所有患者术后1、3个月、末次随访时VAS评分均显著低于术前,JOA评分显著高于术前,差异均有统计学意义(P<0.05);末次随访时观察组患者VAS评分[0(0,1.0)分]显著低于对照组[1(0,2)分],JOA评分[(27.1±1.2)分]、JOA评分优良率93.5%(29/31)显著高于对照组的(25.7±2.1)分、75.8%(25/33),差异均有统计学意义(P<0.05)。对照组有4例患者随访中发现线缆切割出棘突导致内固定失效,失效率为12.1%,观察组未见内固定失效。结论"双稳定构型"椎弓及椎板钉固定法与改良Scott法均能不同程度缓解青少年症状性峡部裂的临床症状,但相比而言,"双稳定构型"椎弓及椎板钉固定法峡部愈合率更高,疗效更为确定。
Objective To compare the efficacy between dual stability constructs and modified Scott techniques for treatment of symptomatic spondylolysis in active adolescents.Methods A retrospective study was conducted to analyze the clinical date of 64 active adolescents who had been treated for symptomatic spondylolysis at Department of Orthopedic Surgery,The 900th Hospital of Joint Logistic Support Force from January 2017 to October 2021.There were 59 males and 5 females with an age of(24.9±5.2)years.Responsible vertebral bodies were L3 in 2 cases,L4 in 10 cases,L5 in 47 cases,and L4 to L5 in 5 cases;spondylolisthesis was accompanied in 9 cases.Depending on the surgical methods,the patients were divided into a dual stability constructs(pedicle screws and laminar screws)group(observation group,31 cases)and a modified Scott group(control group,33 cases).The 2 groups were compared in terms of operative time,bleeding volume,postoperative drainage volume,isthmus healing rate,rate of internal fixation failure,visual analogue scale(VAS)for low back pain,Japanese Orthopaedic Association(JOA)score and the good and excellent rate by JOA at postoperative 1 month,3 months,and the last follow-up,and the incidence of complications.Results There was no statistically significant difference in the preoperative general data between the 2 groups,indicating comparability(P>0.05).All patients were followed up.The operation time in the observation group[(94.7±14.9)min]was significantly longer than that in the control group[(84.4±16.4)min](P=0.011),but there was no significant difference in intraoperative bleeding volume or postoperative drainage volume(P>0.05).The healing rate of bilateral isthmi in the observation group was 93.5%(29/31),significantly higher than that in the control group[60.6%(20/33)],and the rate of internal fixation failure in the observation group(0)was significantly lower than that in the control group(12.1%,4/33)(P<0.05).At postoperative 1 month,3 months,and the last follow-up,the VAS scores were significantly lower than the preoperative value in all patients while the JOA scores significantly higher(P<0.05).At the last follow-up,in the observation group the VAS score[0(0,1.0)]was significantly lower than that in the control group[1(0,2)],and the JOA score[(27.1±1.2)points]and the excellent and good rate by JOA[93.5%(29/31)]were significantly higher than those in the control group[(25.7±2.1)points and 75.8%(25/33)](P<0.05).In the control group,follow-ups revealed internal fixation failure in 4 cases due to the cable cutting out of the spinous processes,yielding a failure rate of 12.1%,while no internal fixation failure was observed in the observation group.Conclusions Both dual stability constructs and modified Scott techniques can relieve the clinical symptoms of spondylolysis in active adolescents to various extents.However,dual stability constructs with pedicle screws and laminar screws may lead to a higher isthmus healing rate and better curative effects.
作者
王辉
孙效棠
吴奇平
曾昊
张志宏
王万明
陈金水
Wang Hui;Sun Xiaotang;Wu Qiping;Zeng Hao;Zhang Zhihong;Wang Wanming;Chen Jinshui(Department of Orthopedic Surgery,The 900th Hospital of Joint Logistic Support Force,PLA,Fuzhou 350000,China;Fuzong College of Clinical Medicine,Fujian Medical University,Fuzhou 350018,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2023年第10期859-865,共7页
Chinese Journal of Orthopaedic Trauma
基金
福建省科技计划项目(社会发展引导性重点项目:2020Y0077)。
关键词
青少年
腰椎
内固定器
峡部裂
双稳定构型
改良Scott
Adolescents
Lumbar vertebrae
Internal fixators
Spondylolysis
Dual stability construct
Modified Scott
作者简介
通信作者:陈金水,Email:cjswater@qq.com。
