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目的探讨青少年腰椎峡部裂采用局部植骨辅助双螺纹空心加压螺钉内固定治疗的临床疗效。方法回顾性分析自2007-01—2009-12采用双螺纹空心加压螺钉结合峡部植骨治疗的56例青少年腰椎峡部裂。比较手术前后Oswestry功能障碍指数(ODI)和疼痛视觉模拟评分(VAS),应用椎间盘内的相对信号强度评价椎间盘退变情况。结果本组手术时间平均65(45~75)min,术中出血量平均80(60~150)ml。所有患者均获得至少60个月随访。CT检查显示峡部裂均获得骨性愈合,愈合时间平均11(10~12)个月。术后12个月时ODI指数为(16.3±2.9)%,较术前明显改善,差异有统计学意义(t=29.986,P<0.001)。术后12个月时VAS评分(0.9±0.4)分,较术前明显降低,差异有统计学意义(t=46.238,P<0.001)。术后60个月时椎间盘内的相对信号强度为0.83±0.11,与术前比较差异无统计学意义(t=1.213,P=0.741)。结论双螺纹空心加压螺钉内固定结合峡部植骨治疗青少年腰椎峡部裂能保留脊柱运动功能单位,创伤小,愈合率较高。
Objective To investigate the clinical effect of local bone graft assisted by double thread hollow compression screw fixation in lumbar spondylolysis. Methods From January 2007 to December 2009, 56 patients with lumbar isthmic spondylolysis underwent treatment of isthmic bone graft with double thread hollow compression screws. The Oswestry Disability Index (ODI) and Pain Visual Analogue Scale (VAS) were compared before and after surgery, and the disc degeneration was evaluated using the relative signal intensity in the disc. Results The average operation time was 65 (45-75) minutes in this group, and the average amount of bleeding during operation was 80 (60-150) ml. All patients were followed for at least 60 months. CT examination showed that the isthmus were bony union, healing time averaging 11 (10 ~ 12) months. The ODI index at 12 months after operation was (16.3 ± 2.9)%, which was significantly improved compared with that before operation. The difference was statistically significant (t = 29.986, P <0.001). The VAS score (0.9 ± 0.4) at 12 months after operation was significantly lower than that before operation (t = 46.238, P <0.001). The relative signal intensity of intervertebral disc at 60 months after operation was 0.83 ± 0.11, which was not significantly different from that before operation (t = 1.213, P = 0.741). Conclusion Internal fixation combined with isthmic bone grafting with double-screw hollow screw fixation can protect spine motor function units of lumbar spondylolysis, with less trauma and higher healing rate.