两种内固定系统治疗腰椎峡部裂伴轻度滑脱的疗效分析

目 的

对比分析Hoist内固定系统与常规内固定系统治疗腰椎峡部裂伴轻度滑脱的疗效。

方 法

回顾性分析2018年12月～2020年12月于我院明确诊断为腰椎峡部裂滑脱、Meyerding分级为Ⅰ度或Ⅱ度（轻度）滑脱患者的病例资料。根据内固定类型分为两组，A组采用Hoist内固定系统（撑开提拉复位系统）；B组为常规钉棒内固定系统。共收集38例患者，其中A组18例，B组20例。比较两组手术时长、出血量、术后引流量、影像学检查所得的滑脱率、滑脱角、椎间隙高度、腰椎前凸角、疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）、日本骨科学会（Japanese Orthopaedic Association，JOA）评分等数据，评价两组的临床疗效。

结 果

38例患者均手术顺利，两组患者性别、年龄、患病时长、责任节段、滑脱分级、术前滑脱率及术前合并症等参数无统计学差异（P＞0.05）。两组患者在术中出血量、术后引流量等指标上无统计学差异（P＞0.05），A组手术时间少于B组（160.8±15.3min vs 184.6±26.9min，P＜0.01）。两组术后滑脱率明显小于术前，滑脱角、椎间隙高度及腰椎前凸角均大于术前（P＜0.01），但术前术后不同时间点两组滑脱率、滑脱角、椎间隙高度、腰椎前凸角等指标无统计学差异（P＞0.05）。两组术后VAS、ODI均明显小于术前（P＜0.01），JOA评分均高于术前（P＜0.05），两组不同时间点VAS、JOA评分无统计学差异（P＞0.05），但术后6个月、12个月时A组的ODI（％）低于B组（18.1±3.2 vs 21.4±2.4；15.2±1.5 vs 16.8±2.0）（P＜0.01）。

结 论

对于Ⅰ、Ⅱ度峡部裂腰椎滑脱患者，应用Hoist内固定系统、常规钉棒内固定系统均有助于帮助患者复位滑脱椎体，重建腰椎功能，获取终末椎间骨性融合，明显改善患者腰椎功能；Hoist内固定系统有助于缩短手术时间。

关键词

腰椎滑脱；峡部裂；内固定；疗效

附 图

图1  Hoist内固定系统构成（提拉螺钉、支撑螺钉、角度连接杆、螺母）

图2  Hoist组典型病例  a~c 术前腰椎正侧位、脊柱全长侧位片示L4椎体Ⅱ度前滑脱，椎间隙塌陷，滑脱率26.1%，椎间隙高度2.9mm d～f 术后1周腰椎正侧位、脊柱全长侧位片示滑脱复位，椎间隙高度恢复，滑脱率2.6%，椎间隙高度11.3mm g、h 术后3个月、术后半年腰椎侧位片示腰椎排列及椎间隙高度保持良好，无内固定松动失效 i、j 术后12个月腰椎CT重建图像示椎间骨性连接

图3  常规组典型病例  a、b 术前腰椎正侧位片示L4椎体Ⅰ度前滑脱，椎间隙塌陷，滑脱率24.6%，椎间隙高度4.9mm c、d 术后1周腰椎正侧位片示滑脱复位，椎间隙高度恢复，滑脱率0%，椎间隙高度11.7mm e、f 术后3个月、术后半年腰椎侧位片示腰椎排列及椎间隙高度保持良好，无内固定松动失效 g、h 术后12个月腰椎CT重建图像示椎间骨性连接

Efficacy analysis of two internal fixation systems in the treatment of lumbar isthmic spondylolisthesis with mild slippage/WANG Dawei, WANG Huadong, LI Li, et al//Chinese Journal of Spine and Spinal Cord, 2022, 32(10): 911-918

Objectives

To compare and analyze the efficacies of Hoist and conventional internal fixation systems in treating lumbar isthmic spondylolisthesis with mild slippage. 

Methods

Patients diagnosed in our hospital with lumbar isthmic spondylolisthesis of Meyerding grade Ⅰ or Ⅱ (mild slippage) between December 2018 and December 2020 were retrospectively analyzed and divided into two groups according to the type of internal fixation. Group A used Hoist internal fixation system (an internal fixation system by propping, lifting and resetting)， and group B used conventional internal fixation system. A total of 38 patients were collected， including 18 in group A and 20 in group B. The clinical efficacy of the two groups was evaluated by comparing the data of the operation time, intraoperative blood loss, postoperative drainage, and the rate of slippage, angle of slippage, height of intervertebral space, and lumbar lordosis angle obtained by imaging examination, and the visual analogue scale (VAS) score, Oswestry disability index (ODI)， and Japanese Orthopaedic Association (JOA) score. 

Results

All 38 patients were operated successfully, and there were no statistical differences in sex, age, duration of illness, responsible segment, grade of slippage, preoperative slippage rate, and preoperative comorbidities between the two groups (P>0.05). There were no significant statistical differences between the two groups in intraoperative blood loss and postoperative drainage volume (P>0.05), but the operation time of group A was less than that of group B (160.8±15.3min vs 184.6±26.9min, P<0.01). The postoperative slippage rates in both groups were significantly smaller than the preoperative ones, and the postoperative slippage angle, the height of intervertebral space, and lumbar lordosis angle were greater than those before operation (P<0.01), while there was no significant difference in all these indicators between the two groups at each time point before or after operation (P>0.05). The postoperative VAS score and ODI were significantly lower than the preoperative ones in both groups (P<0.01), and the postoperative JOA scores were higher than the preoperative ones in both groups (P<0.01). There was no statistical difference in VAS score and JOA score between the two groups at different follow-up time points (P>0.05), but the ODI(％) in group A was lower than that in group B at 6 and 12 months after operation (18.1±3.2 vs 21.4±2.4；15.2±1.5 vs 16.8±2.0) (P<0.01).

Conclusions

For patients with Ⅰ or Ⅱ grade lumbar isthmic spondylolisthesis, both Hoist internal fixation system and conventional internal fixation system are helpful to reset the slipped vertebrae, reconstruct the function of lumbar spine, obtain terminal interbody bony fusion, and improve the function of lumbar spine of patients significantly; the Hoist system can help reduce surgery time.

Key words

Lumbar spondylolisthesis; Spondylolysis; Internal fixation; Treatment effect

Author's address

Spine Surgery Department of Orthopedics Division, the Fourth Medical Center of PLA General Hospital, Beijing, 100048, China